帕金森病人危重疾病性多发性神经病1例临床分析

Critical illness polyneuropathy in a patient with Parkinson disease: a case report and review of the literature

目的分析1例帕金森病人发生危重疾病性多发性神经病的过程、临床特点及早期诊断方法。方法对1例帕金森病危重疾病性多发神经病进行临床资料分析及相关文献回顾。结果该病人败血症过程不典型、发展快,早期以内环境紊乱为表现,很快引起呼吸肌无力,需用呼吸机辅助呼吸,但肢体活动尚好。在有效抗生素应用、内环境紊乱纠正后,仍然难以撒离呼吸机,行肌酶检查和脑脊液检查正常,肌电图发现四肢感觉与运动神经传导速度下降及波幅降低,提示危重疾病性多发神经病可能。结论帕金森病人发生败血症后,出现脱机困难和肢体无力时,应重视神经系统检查,及时观察病情变化和完善肌电图检查,考虑危重疾病性多发性神经病可能。避免危险因素,预防脓毒血症的发生可能是预防本病发生的有效措施。

Objective To report a case of critical illness polyneuropathy（CIP） with Parkinson disease and discuss the development,clinical features and early diagnosis of this condition.Methods The clinical data of a patient with CIP and Parkinson＇s disease and the relevant literature were reviewed.Results This case showed no typical disease course of sepsis,and the condition exacerbated rapidly.The patient presented initially with abnormal homeostasis,followed by rapid onset of respiratory muscle weakness to require mechanical ventilation,but no limb weaknesses were detected.Intravenous antibiotics and aggressive treatment of sepsis did not produce any positive responses to wean from mechanical ventilation.Examinations of creatine kinase and cerebrospinal fluid showed no abnormalities.Electromyography and nerve conduction studies demonstrated declined nerve conduction velocity and decreased sensory and motor muscle action potentials,suggesting the possibility of CIP.Conclusions In patients with Parkinson disease,the occurrence of sepsis with prolonged mechanical ventilation and limb weakness indicates the necessity of neurophysiological examination,muscle biopsies and laboratory tests,which may help detect CIP in the early phase.Proper interventions of sepsis may reduce the likeliness of CIP.Elimination of the risk factors and aggressive management of sepsis can be effective measures for preventing CIP.