重症後虛弱症

重症後虛弱症（intensive careunit–acquired weakness，ICU-AW）是病人入住加護病房後常見的問題，本文透過系統性文獻的整理，介紹重症後虛弱症的定義、致病機轉、危險因子、評估與診斷、以及預防和治療方式。重症後虛弱症是指除了重症疾病之外，找不到其他會造成病人無力的原因，即為重症後虛弱症；其發生率高，不僅直接影響病人活動功能，也造成呼吸器脫離困難，影響生活品質；致病機轉包括發炎反應導致微循環功能失常、藥物使用、代謝改變致血糖增高、以及臥床不動；造成重症後虛弱症的危險因子包括全身性發炎反應、敗血症、多重器官衰竭、高血糖、類固醇和肌肉鬆弛藥物使用、以及臥床不動；重症後虛弱症的評估診斷可以透過理學檢查、電生理檢查、呼吸參數及生物標記等來確認；而要預防及治港重症後虛弱症，應積極治療敗血症、控制血糖、謹慎使用類固醇、避免使用肌肉鬆弛劑過久、盡早執行復健活動等。重症後虛弱症是臨床重要的議題，透過團隊的合作，盡早執行復健活動計畫，可以減少重症後虛弱症的發生及其對病人短期和長期之影響。 Intensive care unit-acquired weakness (ICU-AW) is a common condition in critically ill. This article introduces the definition, pathophysiology, risk factors, assessment and diagnosis, prevention and treatment of ICU-AW through systematic literature review. ICU-AW refers to the fact that in addition to severe diseases, there is no other reason for the patient's weakness; its high incidence, not only directly affects the patient's physical activity, but it also causes difficulty in ventilator weaning and quality of life. Pathophysiological mechanism of ICU-AW includes inflammatory reaction leading to microcirculatory dysfunction, medication, metabolic change leading to hyperglycemia, and bed rest, so risk factors for ICU-AW were systemic inflammatory response, sepsis, multiple organ failure, hyperglycemia, corticosteroids and neuromuscular blocking agents use, and bed rest. ICU-AW can be diagnosed by physical examination, electrophysiological examination, respiratory parameters and biomarkers. To prevent and treat ICU-AW, we should actively treat sepsis and control blood sugar, exposure to corticosteroids limited, shorten administration time of neuromuscular blocking agents, and implement early rehabilitation. ICU-AW is a clinically important issue. Through the cooperation of multidisciplinary team and early implementation of rehabilitation program the incidence of ICU-AW and its short-term and long-term impacts on patients can be reduced.