重症疾病性神经肌肉病(英文课件).ppt
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1、CRITICAL ILLNESS NEUROMYOPATHY,Abbreviations,CIP critical illness polyneuropathy CIM critical illness myopathy CMAP compound muscl action potentials SNAP sensory nerve action potential EMG electromyogram SIRS systematic inflammatory response syndrome,HISTORICAL REVIEW,In 1955 observed a polyneuropat
2、hy after shock or cardiac arrest In 1961 described “coma-polyneuropathies” In 1971 described a polyneuropathy in patients with burns in 1977 severe polyneuropathy about septic patients,By 1983 the term “critical illness polyneuropathy”(CIP) was applied Recently the termed “critical illness myopathy
3、”(CIM) was applied,Studies about Aetiologyvariously,The various factors associated with the SIRS CIP and CIM (Fig. 1) A simplified depiction of theoretical mechanisms of dysfunction in CIP and CIM.(Fig. 2 ) Disorder of microcirculation(Fig. 3),Adapted with permission from Bolton.,Figure. 1,Adapted w
4、ith permission fromBolton25.,Figure. 2,Figure.3 Schematic, theoretical presentation of disturbances in the microcirculation to various organs, including brain, peripheral nerve, and muscle, in SIRS.,Incidence 50%70% SIRS 20%50% ICU, Weakness of limb and respiratory muscle Tendon reflexes absent or d
5、ecrease Distal loss to pain, temperature, and vibration,Clinical Features,The diagnostic criteria for CIP are shown in following Table,Diagnosis,Diagnostic criteria for CIP The patient is critically ill (sepsis and multiple organ failure,SIRS) Difficulty weaning patient from ventilator afternonneuro
6、muscular causes such as heart and lung diseasehave been excluded Possible limb weakness Electrophysiologic evidence of axonal motor and sensory polyneuropathy,Decline in the CMAP amplitude firstly (Fig. 4) Dcline in the SNAP amplitude Motor unit potentials may be reduced in number Single-fiber EMG i
7、ndicate dysfunction of terminal motor axons,Electrophysiologic Features,Measurement of compound thenar muscle action potentials at the onset of sepsis (A) and 3 weeks later (B).,FIG.4,Peripheral axonal degeneration. Moderate loss of dorsal root ganglion cells Central chromatolysis of anterior horn c
8、ells No inflammation in the peripheral nervous system,Morphologic Features,Muscle biopsy Acute and chronic denervation Occasional myopathic changes,Pathology of critical illness polyneuropathy. There is chromatolysis of anterior horn cells (A); severe axonal degeneration in this cross-section of sup
9、erficial peripheral nerve (B) and longitudinal section of deep peroneal nerve (C); and acute and chronic denervation of intercostal muscle (D),Axonal variants of GuillainBarre syndrome Develop earlier Often associated with CJ infection Abnormal cerebral spinal fluid,Differential Diagnosis,Transient
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- 重症 疾病 神经 肌肉 英文 课件
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