加護病房病人的重症系統性乏力

Intensive Care Unit-Acquired Weakness

重症系統性乏力（intensive care unit-acquired weakness）是加護病房病人接受重症治療後才出現的神經肌肉系統性乏力，臨床表徵包含全身性肌肉乏力，可能表現在呼吸肌乏力、吞嚥困難及四肢身體活動功能下降等，一般認為與長期插管治療和全身性炎性反應症候群（systemic inflammatory response syndrome）相關。此外普遍存在加護病房病人的營養失衡問題，進一步影響身體肌肉的合成代謝，也增加肌力恢復的困難。重症系統性乏力一旦發生，復原的過程耗時且困難度高，常需要跨團隊整合照護及時的介入。本文將介紹重症系統性乏力的病生理機轉、診斷及篩檢、後續身體功能影響與預防治療方案，希望能強化醫護人員對加護病房病人重症系統性乏力的識別及照護，進一步促成其後續之功能恢復。

Intensive care unit (ICU)-acquired weakness is a common neuromuscular complication of critical illness that is considered to be associated with prolonged duration on mechanical ventilation and systemic inflammatory response syndrome. In addition, nutrition and metabolic alternations, which are commonly seen in patients in the ICU, may further accelerate muscle wasting and increase the incidence of ICU-acquired weakness. The clinical features of ICU-acquired weakness include acute generalized muscle weakness that develops after the onset of critical illness. Diaphragmatic dysfunction, post-extubation dysphagia, and functional decline also are common in patients with ICU-acquired weakness. As the recovery of these physical functions is lengthy and difficult, a multidisciplinary team management is recommended. This mini-review was conducted to provide a scientific overview for ICU-acquired weakness, including its definition, etiology, diagnosis/screening, impacts, and potential intervention strategies. We hope that increasing the understanding of frontline staff will promote the timely planning and implementation of related screenings and interventions to enhance the functional recovery of patients receiving care in the ICU.