Neurol. pro Praxi, 2001; 2: 67-72

Neuromuskulární komplikace kritického stavu

doc. MUDr. Josef Bednařík, CSc., MUDr. Petr Vondráček
I. neurologická klinika LF MU a FN u sv. Anny Brno

Keywords: kritický stav, sepse, polyneuropatie kritického stavu, myopatie kritického stavu.

Published: December 31, 2001  Show citation

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Bednařík J, Vondráček P. Neuromuskulární komplikace kritického stavu. Neurol. praxi. 2001;2(2):67-72.

Nově vzniklá svalová slabost je významným faktorem prolongované morbidity i mortality kriticky nemocných. Kromě exacerbace preexistujícího nervosvalového onemocnění a perzistující farmakologické blokády nervosvalového přenosu navozené působením nedepolarizujících blokátorů nervosvalového přenosu (NBNP) je nově rozpoznanou příčinou tzv. polyneuropatie (CIP) a myopatie kriticky nemocných (CIM). Tyto komplikace postihují minimálně polovinu kriticky nemocných. Etiopatogeneze je pravděpodobně multifaktoriální. Významným etiologickým faktorem je systémová zánětlivá odpověď (SIRS) a multiorgánové selhání. U CIM je pravděpodobným přídatným faktorem -funkční denervace- navozená NBNP a vysoké dávky kortikosteroidů. Obě jednotky představují součást širšího spektra sekundárního postižení periferního nervového systému a kosterního svalstva ústícího v -nervosvalové selhání- analogické selhání dalších orgánů v rámci kritického stavu. Dosavadní stav poznatků o etiopatogenezi kritického stavu neumožňuje účinnou prevenci či léčbu nervosvalových komplikací.

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