探讨神经危重症患者床旁肌电图检查对患者诊断及预后判断的意义。

对2016年11月至2017年4月在南方医科大学南方医院神经危重症病房（NCU）住院、且住NCU时间超过3 d的58例神经危重症患者进行床旁肌电图检查。检查项目包括运动神经传导、感觉神经传导、直接肌肉刺激。对超过两个肢体共计3条及以上运动和/或感觉神经传导出现异常定义为多发神经传导异常，并进行分组后病因分析、临床特点和电生理特点的比较。

48.3%（28/58）患者呈多发神经传导异常，为多发神经传导异常组，其余30例患者为对照组。与对照组比较，多发神经传导异常组的急性病生理学和长期健康评价（APACHE）Ⅱ评分[（12 ± 5）分vs.（16 ± 6）分]、在院最高脓毒症相关器官衰竭评分（SOFA）分值[4（3，6）分vs. 7（4，11）分]、脓毒症[11/30 vs. 21/28]及多器官功能障碍综合征（MODS）发生率[2/30 vs. 10/28]均更高，预后情况中机械通气时间[0（0，4）d vs. 6（0，16）d]、ICU住院时间[8（5，13）d vs. 14（7，20）d]均更长，出院后30 d [4（3，4）分vs. 5（5，6）分]及90 d [3.0（2.0，4.0）分vs. 6.0（4.2，6.0）分]的改良Rankin评分（mRS）分值、30 d（2/30 vs. 12/28）及90 d（4/30 vs. 15/28）病死情况均更高（P均< 0.05）。多因素Logistic回归分析发现，多发神经传导异常是出院后30 d及90 d病死情况的独立危险因素（P均< 0.05）。多发神经传导异常患者电生理特点显示与其他病因组（14例）比较，危重病性神经肌病（CIPNM）组（14例）运动神经传导未引出复合肌肉动作电位（CMAP）波形的比例更高（6/90 vs. 15/87），而感觉神经传导异常占比均更低（58/83 vs. 28/81、29/37 vs. 14/37、29/44 vs. 14/44；P均< 0.05）。

神经危重症患者常存在周围神经肌肉病变，且病因复杂多样，床旁肌电图检查对神经危重症患者的病因鉴别具有重要意义，且对神经危重症患者预后判断具有重要价值。

To explore the significance of bedside electromyography in diagnosis and prognosis of patients with neurocritical illness.

Fifty-eight patients with critical neurological diseases were included in this research for bedside electromyography study, who were hospitalized more than 3 d in neurological intensive care unit (NCU), Nangfang Hospital, Southern Medical University from November 2016 to April 2017. Abnormal conduction of 3 or more motor and/or sensory nerves in more than two limbs was identified as multiple nerve conduction abnormality. Groups were divided according to results of the electromyography, and then aetiology, electrophysiological and clinical characteristics were compared.

Of the 58 cases, 28 subjects (48.3%) were identified as multiple nerve conduction abnormality, the remaining 30 patients were in the control group. As comparing with the control group, the patients with multiple nerve conduction abnormality were more likely to have higher acute physiology and chronic health evaluation (APACHE)Ⅱscore [(12 ± 5) vs. (16 ± 6)], sepsis-related organ failure assessment (SOFA) score [4 (3, 6) vs. 7 (4, 11)], the incidences of sepsis [11/30 vs. 21/28] and multiple organ dysfunction syndrome (MODS) [2/30 vs. 10/28], as well as longer time of mechanical ventilation [0 (0, 4) d vs. 6 (0, 16) d] and ICU length of stay [8 (5, 13) d vs. 14 (7, 20) d], higher modified Rankin scale (mRS) scores in 30 d [4 (3, 4) vs. 5 (5, 6)] and 90 d [3.0 (2.0, 4.0) vs. 6.0 (4.2, 6.0)] after discharge, and higher mortalities in 30 d (2/30 vs. 12/28) and 90 d (4/30 vs. 15/28) after discharge (all P < 0.05). Multivariate Logistic regression analysis showed that the presence of multiple nerve conduction abnormality was an independent risk factor for the mortalities of 30 d and 90 d after discharge (all P < 0.05). The electrophysiological characteristics of patients with multiple nerve conduction abnormality showed that the proportion of motor nerve conduction not leading to compound muscle action potential (CMAP) waveform was higher (6/90 vs. 15/87) and the rates of abnormal sensory nerve conduction (58/83 vs. 28/81, 29/37 vs. 14/37, 29/44 vs. 14/44) were lower in the critical illness polyneuromyopathy (CIPNM) group (n=14) compared with the other etiological group (n=14).

The patients with neurocritical illness often have peripheral neuromuscular lesions, and have complicated causes. Bedside electromyography is of great significance for the diagnosis and prognosis of patients with critical neurological diseases.