KAYIHAN ULUÇ, Barış İŞAK, TÜLİN TANRIDAĞ, Önder US

Kritik hastalık polinöropatisi ve miyopatisi

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.

Critical illness polyneuropathy and myopathy

Background: Critical illness polyneuropathy (CIP) and clinical illness myopathy (CIM) frequently develop in patients hospitalized in the intensive care unit for more than 1 week. The underlying disorders are usually sepsis and/or multiorgan failure or treatment with neuromuscular blocking agents and steroids. CIP and CIM present with muscle weakness, especially in extremities and respiratory muscles, and failure to wean from mechanical ventilation. While polyneuropathy is an acute axonal one, myopathy has four main types. Encephalopathy which generally occurs before CIP and/or CIM may lead to a delay in diagnosis. Close follow-up of neurological functions, performing electrophysiological and laboratory studies in early period and taking biopsies as indicated leads to correct diagnosis. Early diagnosis and a systematic differential diagnosis of CIP and CIM which are usually seen simultaneously and directly related to survival are important, so that they can be managed properly. Conclusion: The incidence of CIP and CIM may be reduced by eliminating the currently defined risk factors. Although specific therapies have not been discovered, supportive treatment, aggressive management of sepsis and elimination of contributory medications may be beneficial.

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