KRİTİK HASTALIK POLİNÖROPATİSİ VE MİYOPATİSİ

Yıl 2008, Cilt: 21 Sayı: 2, 193 - 202, 24.06.2015

Kayıhan Uluç Barış İşak Tülin Tanrıdağ Tanrıdağ Önder Us

Öz

Bilimsel zemin: Kritik hastalığın nöromusküler belirtileri olan polinöropati ve/veya miyopati, yoğun bakım ünitelerinde bir haftadan daha uzun süre yatan hastalarda gelişir. Sıklıkla altta yatan neden sepsis ve/veya çoklu organ yetmezliği veya steroid-nöromusküler kavşak bloke edici ilaç kullanımıdır. Özellikle ekstremite ve solunum kaslarında kuvvet kaybı ve uzamış mekanik ventilasyon ihtiyacına neden olurlar. Polinöropati akut ve aksonal tarzdadır, miyopati ise dört farklı tipte kendini gösterebilir. Genellikle bu hastalıklar gelişmeden önce görülen ensefalopati tablosu hastaların geç tanı almalarına sebebiyet vermektedir. İyi klinik izlem, erken evrede yapılacak elektrofizyolojik ve laboratuar çalışmalar, gerekli durumlarda alınacak biyopsi doğru tanıyı kolaylaştırır. Sıklıkla bir arada görülen bu hastalıkların erken evrede doğru tanı almaları ve ayırıcı tanılarının ayrıntılı yapılması önemlidir, çünkü bu sayede doğru tedavi uygulanabilir, ayrıca sağkalım üzerine doğrudan etkili olan bu hastalıklar ile mücadele edilebilinir. Çıkarımlar: Günümüzde daha iyi tanımlanmaya başlanan risk faktörlerinin elimine edilmesi bu hastalıkların görülebilirliklerini azaltabilir. Henüz özgül bir tedavi olmasa da, destekleyici tedaviler, sepsis ile agresif savaşım, hastalığa neden olabilecek medikal tedavilerin uzaklaştırılması hastaya yarar sağlayabilir.

Anahtar Kelimeler: Kritik hastalık, polinöropati, miyopati

Anahtar Kelimeler

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Kaynakça

• Bolton CF. Neuromuscular manifestations of critical
• illness. Muscle Nerve 2005;32(2):140-163
• Visser LH. Critical illness polyneuropathy and
• myopathy: clinical features, risk factors and
• prognosis. Eur J Neurol 2006;13(11):1203-1212
• Hund E. Neurological complications of sepsis:critical
• illness polyneuropathy and myopathy. J Neurol
• ;248:929-934
• Latronico N, Peli E, Botteri M. Critical illness
• myopathy and neuropathy. Curr Opin Crit Care
• ;11(2):126-132
• Bolton CF, Gilbert JJ, Hahn AF, Sibbald WJ.
• Polyneuropathy in critically ill patients. J Neurol
• Neurosurg Psychiatry 1984;47:1223-1231
• Bolton CF, Laverty DA, Brown JD, Witt NJ, Hahn
• AF, Sibbald WJ. Critically ill polyneuropathy:
• electrophysiological studies and differentiation from
• Guillain-Barre syndrome. J Neurol Neurosurg
• Psychiatry 1986;49:563-573
• Leijten FS, De Weerd AW, Poortvliet DC, De Ridder
• VA, Ulrich C, Harink-De Weerd JE. Critical illness
• polyneuropathy in multiple organ dysfunction
• syndrome and weaning from the ventilator. Intensive
• Care Med 1996;22(9):856-861
• Witt NJ, Zochodne DW, Bolton CF, Grand'Maison F,
• Wells G, Young GB, Sibbald WJ. Peripheral nerve
• function in sepsis and multiple organ failure. Chest
• ;99(1):176-184
• Tennila A, Salmi T, Pettila V, Roine RO, Varpula T,
• Takkunen O. Early signs of critical illness
• polyneuropathy in ICU patients with systemic
• inflammatory response syndrome or sepsis. Intensive
• Care Med 2000;26(9):1360-1363
• Druschky A, Herkert M, Radespiel-Troger M,
• Druschky K, Hund E, Becker CM, Hilz MJ, Erbguth
• F, Neundorfer B. Critical illness polyneuropathy:
• clinical findings and cell culture assay of
• neurotoxicity assessed by a prospective study.
• Intensive Care Med 2001;27(4):686-693
• Latronico N, Fenzi F, Recupero D, Guarneri B,
• Tomelleri G, Tonin P, De Maria G, Antonini L,
• Rizzuto N, Candiani A. Critical illness myopathy and
• neuropathy. Lancet 1996;347(9015):1579-1582
• Fenzi F, Latronico N, Refatti N, Rizzuto N. Enhanced
• expression of E-selectin on the vascular endothelium
• of peripheral nerve in critically ill patients with
• neuromuscular disorders. Acta Neuropathol (Berl)
• ;106(1):75-82
• de Letter MA, Schmitz PI, Visser LH, Verheul FA,
• Schellens RL, Op de Coul DA, van der Meche FG.
• Risk factors for the development of polyneuropathy
• and myopathy in critically ill patients. Crit Care Med
• ;29(12):2281-2286
• Sander HW, Golden M, Danon MJ. Quadriplegic
• areflexic ICU illness: selective thick filament loss and
• normal nerve histology. Muscle Nerve
• ;26(4):499-505
• Verheul GA, de Jongh-Leuvenink J, Op de Coul AA,
• van Landeghem AA, van Puyenbroek MJ. Tumor
• necrosis factor and interleukin-6 in critical illness
• polyneuromyopathy. Clin Neurol Neurosurg
• ;96(4):300-304
• Coakley JH, Nagendran K, Yarwood GD, Honavar M,
• Hinds CJ. Patterns of neurophysiological abnormality
• in prolonged critical illness. Intensive Care Med
• ;24(8):801-807
• Zifko UA, Zipko HT, Bolton CF. Clinical and
• electrophysiological findings in critical illness
• polyneuropathy. J Neurol Sci 1998;159(2):186-193
• Op de Coul AA, Lambregts PC, Koeman J, van
• Puyenbroek MJ, Ter Laak HJ, Gabreels-Festen AA.
• Neuromuscular complications in patients given
• Pavulon (pancuronium bromide) during artificial
• ventilation. Clin Neurol Neurosurg 1985;87(1):17-22
• Kupfer Y, Namba T, Kaldawi E, Tessler S. Prolonged
• weakness after long-term infusion of vecuronium
• bromide. Ann Intern Med 1992;117(6):484-486
• Khan J, Harrison TB, Rich MM, Moss M. Early
• development of critical illness myopathy and
• neuropathy in patients with severe sepsis. Neurology
• ;67(8):1421-1425
• Low PA NK, Seionti L. Role of hypoxia, oxidative
• stress, and excitatory neurotoxins in diabetic
• neuropathy. In: Dyck PJ TP, editor. Diabetic
• neuropathy. 2nd ed. Philadelphia: WB Saunders;
• p 317-329
• Maher J, Rutledge F, Remtulla H, Parkes A, Bernardi
• L, Bolton CF. Neuromuscular disorders associated
• with failure to wean from the ventilator. Intensive
• Care Med 1995;21(9):737-743
• Sander HW, Saadeh PB, Chandswang N, Greenbaum
• D, Chokroverty S. Diaphragmatic denervation in
• intensive care unit patients. Electromyogr Clin
• Neurophysiol 1999;39(1):3-5
• Hund E, Genzwurker H, Bohrer H, Jakob H, Thiele R,
• Hacke W. Predominant involvement of motor fibres
• in patients with critical illness polyneuropathy. Br J
• Anaesth 1997;78(3):274-278
• Rich MM, Teener JW, Raps EC, Schotland DL, Bird
• SJ. Muscle is electrically inexcitable in acute
• quadriplegic myopathy. Neurology 1996;46(3):731-
• -
• Zochodne DW, Bolton CF, Wells GA, Gilbert JJ,
• Hahn AF, Brown JD, Sibbald WA. Critical illness
• polyneuropathy. A complication of sepsis and
• multiple organ failure. Brain 1987;110 ( Pt 4):819-
• -
• Lycklama J NA, Troost J. Critical illness
• polyneuropathy. In: WB M, editor. Handbook of
• clinical neurology. New York: Elsevier Science;
• p 129-135
• Dellinger RP, Carlet JM, Masur H, Gerlach H,
• Calandra T, Cohen J, Gea-Banacloche J, Keh D,
• Marshall JC, Parker MM, Ramsay G, Zimmerman JL,
• Vincent JL, Levy MM. Surviving Sepsis Campaign
• guidelines for management of severe sepsis and septic
• shock. Intensive Care Med 2004;30(4):536-555
• Lowry SF. Sepsis and its complications: clinical
• definitions and therapeutic prospects. Crit Care Med
• ;22(7):S1-2
• -
• Marmara Medical Journal 2008;21(2);193-202
• Kayıhan Uluç, Ark.
• Kritik hastalık polinöropatisi ve miyopatisi
• Garnacho-Montero J, Madrazo-Osuna J, GarciaGarmendia
• JL, Ortiz-Leyba C, Jimenez-Jimenez FJ,
• Barrero-Almodovar A, Garnacho-Montero MC,
• Moyano-Del-Estad MR. Critical illness
• polyneuropathy: risk factors and clinical
• consequences. A cohort study in septic patients.
• Intensive Care Med 2001;27(8):1288-1296
• Bolton CF, Young GB, Zochodne DW. The
• neurological complications of sepsis. Ann Neurol
• ;33(1):94-100
• van der Schaaf M, Beelen A, de Groot IJ. Critical
• illness polyneuropathy: a summary of the literature on
• rehabilitation outcome. Disabil Rehabil
• ;22(17):808-810
• van der Schaaf M, Beelen A, de Vos R. Functional
• outcome in patients with critical illness
• polyneuropathy. Disabil Rehabil 2004;26(20):1189-
• -
• Leijten FS, Harinck-de Weerd JE, Poortvliet DC, de
• Weerd AW. The role of polyneuropathy in motor
• convalescence after prolonged mechanical ventilation.
• Jama 1995;274(15):1221-1225
• Mohr M, Englisch L, Roth A, Burchardi H, Zielmann
• S. Effects of early treatment with immunoglobulin on
• critical illness polyneuropathy following multiple
• organ failure and gram-negative sepsis. Intensive Care
• Med 1997;23(11):1144-1149
• van den Berghe G, Wouters P, Weekers F, Verwaest
• C, Bruyninckx F, Schetz M, Vlasselaers D,
• Ferdinande P, Lauwers P, Bouillon R. Intensive
• insulin therapy in the critically ill patients. N Engl J
• Med 2001;345(19):1359-1367
• Van den Berghe G, Schoonheydt K, Becx P,
• Bruyninckx F, Wouters PJ. Insulin therapy protects
• the central and peripheral nervous system of intensive
• care patients. Neurology 2005;64(8):1348-1353
• Langouche L, Vanhorebeek I, Vlasselaers D, Vander
• Perre S, Wouters PJ, Skogstrand K, Hansen TK, Van
• den Berghe G. Intensive insulin therapy protects the
• endothelium of critically ill patients. J Clin Invest
• ;115(8):2277-2286
• Mesotten D, Swinnen JV, Vanderhoydonc F, Wouters
• PJ, Van den Berghe G. Contribution of circulating
• lipids to the improved outcome of critical illness by
• glycemic control with intensive insulin therapy. J Clin
• Endocrinol Metab 2004;89(1):219-226
• Douglass JA, Tuxen DV, Horne M, Scheinkestel CD,
• Weinmann M, Czarny D, Bowes G. Myopathy in
• severe asthma. Am Rev Respir Dis 1992;146(2):517-
• -
• Campellone JV, Lacomis D, Kramer DJ, Van Cott
• AC, Giuliani MJ. Acute myopathy after liver
• transplantation. Neurology 1998;50(1):46-53
• Perea M, Picon M, Miro O, Orus J, Roig E, Grau JM.
• Acute quadriplegic myopathy with loss of thick
• (myosin) filaments following heart transplantation. J
• Heart Lung Transplant 2001;20(10):1136-1141
• Rich MM, Pinter MJ, Kraner SD, Barchi RL. Loss of
• electrical excitability in an animal model of acute
• quadriplegic myopathy. Ann Neurol 1998;43(2):171-
• -
• Rich MM, Pinter MJ. Sodium channel inactivation in
• an animal model of acute quadriplegic myopathy.
• Ann Neurol 2001;50(1):26-33
• Rich MM, Pinter MJ. Crucial role of sodium channel
• fast inactivation in muscle fibre inexcitability in a rat
• model of critical illness myopathy. J Physiol
• ;547(Pt 2):555-566
• Brealey D, Brand M, Hargreaves I, Heales S, Land J,
• Smolenski R, Davies NA, Cooper CE, Singer M.
• Association between mitochondrial dysfunction and
• severity and outcome of septic shock. Lancet
• ;360(9328):219-223
• Tiao G, Hobler S, Wang JJ, Meyer TA, Luchette FA,
• Fischer JE, Hasselgren PO. Sepsis is associated with
• increased mRNAs of the ubiquitin-proteasome
• proteolytic pathway in human skeletal muscle. J Clin
• Invest 1997;99(2):163-168
• Sher JH, Shafiq SA, Schutta HS. Acute myopathy
• with selective lysis of myosin filaments. Neurology
• ;29(1):100-106
• Showalter CJ, Engel AG. Acute quadriplegic
• myopathy: analysis of myosin isoforms and evidence
• for calpain-mediated proteolysis. Muscle Nerve
• ;20(3):316-322
• Sitwell LD, Weinshenker BG, Monpetit V, Reid D.
• Complete ophthalmoplegia as a complication of acute
• corticosteroid- and pancuronium-associated
• myopathy. Neurology 1991;41(6):921-922
• Zochodne DW, Ramsay DA, Saly V, Shelley S,
• Moffatt S. Acute necrotizing myopathy of intensive
• care: electrophysiological studies. Muscle Nerve
• ;17(3):285-292