神经肌肉性呼吸衰竭与ICU

Neuromuscular respiratory failure in ICU

多种神经机能紊乱可导致急性全身性衰弱以致住院治疗．接受神经系统评估；神经肌肉系统的严重病变也见于ICU中的危重病人。呼吸肌常受累于多种病例中。可导致通气不足．高碳酸血症性呼衰。增加或延长呼吸机的使用。对于严密监测的有神经肌肉衰弱的病人来说．早期发现其呼吸衰竭征象并立即进行呼吸支持是很关键的；可能还需要对病人进行插管以维持气道通畅。插管时。病人有很高风险患肺炎等致死性的并发症。及时发现潜在的神经肌肉性病变有助于进行有效的治疗和预后判断。以及避免呼吸机的应用。当临床诊断不明确。或需要进一步评估预后情况时．选择性地进行肌电图（EMG）．神经／肌肉等辅助检查是很有帮助的。

A wide variety of neurologic disorders cause acute generalized weakness precipitating hospital admission and neurologic evaluation; serious dysfunction of the neuromuscular system also occurs in critically ill patients in the intensive care unit. Respiratory muscles are commonly affected in either case, leading to hypoventilation, hypercapnic respiratory failure, and the need for （or prolongation of） mechanical ventilation （MV）.Closely monitoring patients with neuromuscular weakness is critical in recognizing early signs of respiratory failure and guiding the need for prompt ventilatory support; patients may also need to be intubated for airway protection. While intubated, these patients are at high risk for complications such as ~neumonia that contribute to mortality. The proper recognition of the underlying neuromuscular disorder allows appropriate management and discussion of prognosis, including weaning from MV.Selective use of ancillary testing, such as EMG and nerve/muscle biopsy, may help when the clinical diagnosis is unclear and further assist with estimating recovery.