重症多神經病變及肌病變之案例討

Polyneuropathy and Myopathy in a Case of Critical Illness

個案為56歲男士，因敗血症及嚴重氣喘緊急插管入加護病房，住院期間因困難脫離呼吸器，因此長時間併用全身性類固醇及神經肌肉阻斷劑，停止使用鎮靜劑後病人意識清醒，但僅能於指頭未稍出現動度；個案經停用神經肌肉阻斷劑後於第11天漸漸恢復四肢肌力。推測造成神經肌肉無力的可能原因與使用全身性類固醇及神經肌肉阻斷劑相關，另外，也可能與血糖控制不佳有關。

We present a 56-year-old male who had been admitted to the intensive care unit due to sepsis and endotracheal intubation was done for acute respiratory failure. During the hospitalization, difficulty in ventilator weaning was noted and the patient had been under prolonged use of systemic corticosteroids and muscle relaxants. After cessation of sedatives, the patient was found with improved consciousness yet remained limited muscle power. It was not until 11days after discontinuation of neuromuscular blocking agents did the patient recover with improving muscle power over the limbs. Use of prolonged systemic corticosteroids and neuromuscular blocking agents were suspected to be related to the patient’s symptoms of neuromyopathy and muscle weakness. However, poor control of blood sugar might as well contribute to the clinical manifestation.