Neuromuskuläre Folgen der Sepsis

Zusammenfassung

Die „Critical illness”-Polyneuropathie und die „Critical illness”-Myopathien stellen spezifische neuromuskuläre Komplikationen von Sepsis bzw. der mit ihr assoziierten Entzündungsreaktion (SIRS) dar. Klinisch resultiert eine generalisierte Muskelschwäche, die die Entwöhnung vom Respirator verzögert und häufig eine neuromuskuläre Rehabilitation erfordert. Die Pathogenese dieser Sepsis-induzierten Komplikationen ist bis heute nicht ausreichend geklärt. Die Diagnose einer Neuropathie lässt sich elektrophysiologisch stellen, bei den Myopathien ist eine Biopsie erforderlich. Nach Beendigung der Intensivbehandlung bilden sich die Symptome spontan zurück, schwere Verläufe können allerdings lebenslange neuromuskuläre Defizite hinterlassen.

Summary

Critical illness polyneuropathy and critical illness myopathies represent specific neuromuscular sequelae of sepsis. Affected patients have generalized muscle weakness which, in turn, causes delay in weaning from the respirator and requires neuromuscular rehabilitation. The pathogenesis of sepsis-induced neuromuscular syndromes is not clear, but most authors agree that the inflammatory responses of the host triggered by sepsis play a major role. Diagnosis of neuropathy is made by clinical electrophysiology; with repect to myopathy, a biopsy is required to account for the histologic type. The course of either neuropathy and myopathy is monophysic, i.e. symptoms resolve spontaneously after termination of intensive care. Severe cases, however, can have incomplete recovery with life-long deficits.

Schlüsselwörter

Sepsis - Komplikationen - Lähmung - Atrophie - Beatmung

Key words

Sepsis - complications - paresis - atrophy - weaning failure

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