Průběh nervosvalových komplikací u pacientů v intenzivní péči
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1 Průběh nervosvalových koplikací u pacientů v intenzivní péči 1 Zdeněk Lukáš,, 2 Jan Maňák, 3 Josef Bednařík 1 Ústav patologie,, FN Brno 2 Jednotka intenzivní péče,, FN Hradec Králové 3 Neurologická klinika,, FN Brno
2 Histopathologic diagnosis Sybol No EMG diagnosis No Neurogenic lesion N 2 18 Siple (cachectic) yopathy Ms 15 9 Necrotizing yopathy Mn Myosin loss yopathy M M(N) 19 9 Fibre type 2 atrophy Atr2 Minial change yopathy Mini 6 Noral finding Nor 1 0 Not done ND 0 7 Σ 43 43
3 Aortic valve replaceent yes yes 195, 6 Mn Patient No Day Age Clinical diagnosis Sepsis MO F CK Histopat Neurol - E M G Ardu an HCA DEX Bronchopneuonia yes yes 15,8 Mini ND Aortic dissection,rhabdoyolysis yes yes 52,0 Nor ND seq Aortic valve replaceent yes yes Atr2 + yopathy seq Myocardial revascularization yes yes 546, 7 Ms(N) + yopathy Revascularization of yocardiu yes yes 4,1 Mini Myocardial revascularization yes yes 8,8 Mini GI bleeding yes yes 6,0 N ND Urosepsis yes yes 17,0 Ms ND Aortic dissection yes yes 15,1 Ms(N) seq Malignant lyphoa yes yes 2,4 Ms 0 ### Intraabdoinal sepsis yes yes 8,9 Ms(N) 4 ### Atrial septal defect yes yes 1,3 Ms Atr Revascularization of yocardiu yes yes 2,1 Ms Atr Peritonitis yes yes 74,6 Mini ND Cholangitis yes yes 3,5 Ms Myocardial infarction yes yes 246, 7 Ms M Intracerebral haeatoa yes yes 2,8 Ms N + yopathy Brain contusion yes yes 2,8 Ms Brain ischeia yes yes 3,1 Ms(N) + yopathy 0 0 0
4 Acute pancreatitis yes yes 4,8 Ms(N) seq Pulonary ebolis yes yes 64,0 Mn(N) Brain ischeia yes yes 3,5 Ms Meningoencephalitis yes yes 0,4 Ms N seq Mediastinits yes yes 96,1 Mn Atr2 + yopathy Pulonary abscess yes yes 43,9 Mn 16 ns ns Ileus - peritoninis yes yes 9,8 Ms Atr Septic shock yes yes 20,1 Ms(N) seq Pancreatitis yes yes 1,3 Minial Bacterial pericarditis yes yes 1,2 Mn M ND seq Aortic valve replaceent yes yes 404, 3 Mn Basilar throbosis yes yes 30,5 Mini ND Acute pancrereatitis yes yes 1,5 Ms(N) Cardiac arrest yes yes 5,1 Ms(N) Subarachnoid haeorrhage yes yes 2,6 Ms Acute pancrereatitis yes yes 0,2 M Intracerebral haeatoa yes yes 42,8 Ms Acute pancreatitis yes yes 13,6 Ms(N) + yopathy seq Aortic valve replaceent yes yes 2,5 Ms(N) + yopathy Brain ischeia yes yes 10,1 N + yopathy Aortic valve replaceent yes yes 4,0 Ms + yopathy seq Acute pancreatitis yes yes 24,6 Ms GI bleeding yes yes 1,2 Ms(N)
5 Patient No Clinical background Neurological finding (1) EMG (1) Biopsy (1) Interval Neurological finding (2) EMG (2) Biopsy (2) 3 Aortic valve replaceent quadruplegia Mixed lesion Atr 2 5 weeks Marked iproveent Mixed lesion Atr 2 10 Non Hodgkin ML, cheo MOF, sepsis quadruplegia Mild siple yopathy 1 week Rhabdoyolysis, quadruplegia Severe necrotizing yopathy
6 Σ bioptický nález se v průběhu oneocnění ění a reflektuje aktuální stav pacienta v intenzivní péči nutnost správného načasování doby vyšetření
7 Patient No Clinical background 4 Ao-coronary bypass, sepsis, rhabdoyolysis Neurolo gical finding (1) 2,3 EMG (1) Biopsy (1) Int. Neurological finding (2) EMG (2) Biopsy (2) 31 Abulatory with 1 stick, acral dysesthesia 3,4 Neuropathy 22 Pulonary ebolis, rhabdoyolysis, l egia 0,6 20 Fully abulatory with peroneal p, acral paresthesia 3,8 (iproved) Noral 25 Mediastinitis, sepsis, MOF 0,9 Neuroyopat hy 20 Fully abulatory with peroneal p, acral paresthesia 3,5 (iproved) Minial change yopathy 29 Biliary pancreatitis, sepsis, MOF MRC not done 21 Abulatory with 2 sticks MRC not done (iproved) Neuropathy, yosin loss 31 Aortic valve replaceent, sepsis, MOF, DIC l egia 0,2 deyeli nating 29 Fully abulatory with peroneal p, acral paresthesis 4,5 Persisting axonal Noral 39 Aortic valve replaceent, MOF, sepsis, 0,9, yopat hy 20 Abulatory with peroneal p 4,0 Persisting axonal Minial change yopathy-noral 42 Acute pancreatitis, sepsis, MOF Muscle weakness MRC av 3,0, fibre type 2 atrophy 11 Noral MRC av 5,0 Persisting axonal Noral
8 Patient test1 test2 31 0,2 4,5 25 0,9 3,5 4 2,3 3,4 39 0, ,6 3, Vývoj svalové síly test1 test2
9 Patient No Clinical background 4 Ao-coronary bypass, sepsis, rhabdoyolysis Neurolo gical finding (1) 2,3 EMG (1) Biopsy (1) Int. Neurological finding (2) EMG (2) Biopsy (2) 31 Abulatory with 1 stick, acral dysesthesia 3,4 Neuropathy 22 Pulonary ebolis, rhabdoyolysis, l egia 0,6 20 Fully abulatory with peroneal p, acral paresthesia 3,8 (iproved) Noral 25 Mediastinitis, sepsis, MOF 0,9 Neuroyopat hy 20 Fully abulatory with peroneal p, acral paresthesia 3,5 (iproved) Minial change yopathy 29 Biliary pancreatitis, sepsis, MOF MRC not done 21 Abulatory with 2 sticks MRC not done (iproved) Neuropathy, yosin loss 31 Aortic valve replaceent, sepsis, MOF, DIC l egia 0,2 deyeli nating 29 Fully abulatory with peroneal p, acral paresthesis 4,5 Persisting axonal Noral 39 Aortic valve replaceent, MOF, sepsis, 0,9, yopat hy 20 Abulatory with peroneal p 4,0 Persisting axonal Minial change yopathy-noral 42 Acute pancreatitis, sepsis, MOF Muscle weakness MRC av 3,0, fibre type 2 atrophy 11 Noral MRC av 5,0 Persisting axonal Noral
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12 Σ: yogenní složka ICM je časově oezená
13 Σ: : EMG znáky přetrvávající či residuální axonální - popsaný rovněž ve dvou dosavadních sděleních Hund EF, Fogel W, Krieger D, DeGeorgia M, Hacke W. Critical illness poly: clinical findings outcoes of a frequent cause of neurouscular weaning failure. Crit Care Med 1996; 24: 1996 Fletcher SN, Keedy DD, Ghosh IR, et al. Persistent neurouscular neurophysiologic abnoralities in long-ter survivors of prolonged critical illness. Crit Care Med 2003; 31: o déledobé vývoji neuropatie kriticky neocných - nereflektují dostatečně klinický stav pacienta. V toto sěru stojí bioptický nález nái vyšetřených pacientů blíže klinickéu obrazu
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