儿科重症监护病房获得性肌无力的研究进展

doi:10.12372/jcp.2026.26e0158

临床儿科杂志 ›› 2026, Vol. 44 ›› Issue (8): 761-768.doi: 10.12372/jcp.2026.26e0158

• 文献综述 • 上一篇

儿科重症监护病房获得性肌无力的研究进展

丁秋元¹^,³^,⁴^,⁵, 周亮²^,³^,⁴^,⁵()

¹ 重庆医科大学附属儿童医院重症医学科
² 重庆医科大学附属儿童医院急诊科
³ 儿童少年健康与疾病国家临床医学研究中心
⁴ 儿童发育疾病研究教育部重点实验室
⁵ 儿童医疗大数据智能应用重庆市高校工程研究中心（重庆 400014）

收稿日期:2026-02-09 修回日期:2026-03-27 录用日期:2026-06-22 出版日期:2026-08-15 发布日期:2026-08-03
通讯作者: 周亮 E-mail:756716589@qq.com
作者简介:第一联系人：作者贡献（Authors’ Contributions）
丁秋元负责文献筛选、资料提取、论文撰写；周亮负责研究指导、论文修改。

Research progress of pediatric intensive care unit-acquired weakness

DING Qiuyuan¹^,³^,⁴^,⁵, ZHOU Liang²^,³^,⁴^,⁵()

¹ Department of Intensive Care Unit Children's Hospital of Chongqing Medical University
² Department of Emergency Children's Hospital of Chongqing Medical University
³ National Clinical Research Center for Children and Adolescents' Health and Diseases
⁴ Ministry of Education Key Laboratory of Child Development and Disorders
⁵ Intelligent Application of Big Data in Pediatrics Engineering Research Center of Chongqing Education Commission of China, Chongqing 400014, China

Received:2026-02-09 Revised:2026-03-27 Accepted:2026-06-22 Published:2026-08-15 Online:2026-08-03
Contact: ZHOU Liang E-mail:756716589@qq.com

摘要/Abstract

摘要：

重症监护病房获得性肌无力（ICU-AW）是患者在危重疾病期间发生的继发性神经肌肉综合征，主要表现为新发肢体对称性肌无力、肌肉萎缩和脱机困难。这一疾病在成人患者中已得到充分的重视。但是，ICU-AW在危重症儿童中的报道较少，儿科重症监护病房（PICU）对该病的认识尚有欠缺。因此，本文综述了关于ICU-AW的儿科领域文献，从流行病学、危险因素、病理生理学、诊断标准及方法、预防和治疗等方面全面总结目前学界对儿科ICU-AW的认识。现阶段，关于儿童ICU-AW的研究尚不充分，诊断标准不统一，提示需要进一步的临床研究以加深并统一对该疾病的认识。减少PICU-AW发生的危险因素以及早期活动、减少镇静和神经肌肉电刺激治疗，可能是预防和治疗PICU-AW的有效措施。

关键词: 儿科, 重症监护病房获得性肌无力, 危重病性多发性神经病, 危重病性肌病, 临床特征

Abstract:

Intensive care unit-acquired weakness (ICU-AW) is a secondary neuromuscular syndrome occurring during critical illness, mainly manifesting as new-onset symmetrical limb weakness, muscle atrophy, and difficulty weaning from ventilation. This condition is well recognized in adult patients. However, there are few reports of ICU-AW in critically ill children, and awareness of the disease remains inadequate in the pediatric intensive care unit (PICU). Therefore, this article reviews the pediatric literature on ICU-AW and comprehensively summarizes the current academic understanding of pediatric ICU-AW in terms of epidemiology, risk factors, pathophysiology, diagnostic criteria and methods, and prevention and treatment. At this stage, research on pediatric ICU-AW is still insufficient with no unified diagnostic criteria, indicating that further clinical studies are required to deepen and unify the understanding of this disease. Reducing the risk factors for PICU-AW, as well as early mobilization, reduced sedation, and neuromuscular electrical stimulation therapy, may be effective measures for the prevention and treatment of PICU-AW.

Key words: pediatric, intensive care unit-acquired weakness, critical illness polyneuropathy, critical illness myopathy, clinical features

中图分类号:

丁秋元, 周亮. 儿科重症监护病房获得性肌无力的研究进展[J]. 临床儿科杂志, 2026, 44(8): 761-768.

DING Qiuyuan, ZHOU Liang. Research progress of pediatric intensive care unit-acquired weakness[J]. Journal of Clinical Pediatrics, 2026, 44(8): 761-768.

图/表 1

参考文献 39

[1]	Fan E, Cheek F, Chlan L, et al. An official American Thoracic Society Clinical Practice guideline: the diagnosis of intensive care unit-acquired weakness in adults[J/OL]. Am J Respir Crit Care Med, 2014, 190(12): 1437-1446. https://doi.org/10.1164/rccm.201411-2011ST.
[2]	Huang A, Salazar M, Weber H, et al. ICU-acquired weakness: Critical illness myopathy and polyneuropathy[J/OL]. J Crit Care, 2025, 88: 155074. https://doi.org/10.1016/j.jcrc.2025.155074.
[3]	Chen J, Huang M. Intensive care unit-acquired weakness: Recent insights[J/OL]. J Intensive Med, 2023, 4(1): 73-80. https://doi.org/10.1016/j.jointm.2023.07.002.
[4]	Sidiras G, Patsaki I, Karatzanos E, et al. Long term follow-up of quality of life and functional ability in patients with ICU acquired Weakness - A post hoc analysis[J/OL]. J Crit Care, 2019, 53: 223-230. https://doi.org/10.1016/j.jcrc.2019.06.022.
[5]	Latronico N, Rasulo FA, Eikermann M, et al. Illness weakness, polyneuropathy and myopathy: diagnosis, treatment, and long-term outcomes[J/OL]. Crit Care, 2023, 27(1): 439. https://doi.org/10.1186/s13054-023-04676-3.
[6]	Williams S, Horrocks IA, Ouvrier RA, et al. Critical illness polyneuropathy and myopathy in pediatric intensive care: A review[J/OL]. Pediatr Crit Care Med, 2007, 8(1): 18-22. https://doi.org/10.1097/01.pcc.0000256623.01254.40.
[7]	Kukreti V, Shamim M, Khilnani P. Intensive care unit acquired weakness in children: Critical illness polyneuropathy and myopathy[J/OL]. Indian J Crit Care Med, 2014, 18(2): 95-101. https://doi.org/10.4103/0972-5229.126079.
[8]	Huang D, Zhang W, Peng W, et al. Knowledge, attitudes and practices regarding children with ICU-acquired weakness in pediatric intensive care unit among chinese medical staff: a cross-sectional survey[J/OL]. BMC Nurs, 2023, 22(1): 162. https://doi.org/10.1186/s12912-023-01304-x.
[9]	Mohamed A, Ryan MM. Neuromuscular complications of intensive care[J/OL]. Handb Clin Neurol, 2013, 113: 1481-1483. https://doi.org/10.1016/B978-0-444-59565-2.00017-4.
[10]	Banwell BL, Mildner RJ, Hassall AC, et al. Muscle weakness in critically ill children[J/OL]. Neurology, 2003, 61(12): 1779-1782. https://doi.org/10.1212/01.wnl.0000098886.90030.67.
[11]	Field-Ridley A, Dharmar M, Steinhorn D, et al. ICU-acquired weakness is associated with differences in clinical outcomes in critically ill children[J/OL]. Pediatr Crit Care Med, 2016, 17(1): 53-57. https://doi.org/10.1097/PCC.0000000000000538.
[12]	Kasinathan A, Sharawat I K, Singhi P, et al. Intensive care unit-acquired weakness in children: a prospective observational study using simplified serial electrophysiological testing (PEDCIMP Study)[J/OL]. Neurocrit Care, 2021, 34(3): 927-934. https://doi.org/10.1007/s12028-020-01123-x.
[13]	Ding M, Yang C, Qin Y, et al. Risk factors and 6-month outcomes of paediatric intensive care unit-acquired weakness[J/OL]. Aust Crit Care, 2025, 38(5): 101294. https://doi.org/10.1016/j.aucc.2025.101294.
[14]	Bilan N, Sadegvand S, Ranjbar S. Therapeutic effect of insulin in reducing critical illness; polyneuropathy and myopathy in the pediatric intensive care unit[J/OL]. Iran J Child Neurol, 2012, 6(3): 9-13. https://pmc.ncbi.nlm.nih.gov/articles/PMC3943028/.
[15]	Thabet MA, Tawfik M, Abd ENS, et al. Neurophysiological study of critical illness polyneuropathy and myopathy in mechanically ventilated children; additional aspects in paediatric critical illness comorbidities[J/OL]. Eur J Neurol, 2018, 25(7): 991-e76. https://doi.org/10.1111/ene.13649.
[16]	Shubham S, Dhochak N, Singh A, et al. Polyneuropathy in critically ill mechanically ventilated children: experience from a tertiary care hospital in north india[J/OL]. Pediatr Crit Care Med, 2019, 20(9): 826-831. https://doi.org/10.1097/PCC.0000000000002012.
[17]	Hiser SL, Casey K, Nydahl P, et al. Intensive care unit acquired weakness and physical rehabilitation in the ICU[J/OL]. BMJ, 2025, 388: e077292. https://doi.org/10.1136/bmj-2023-077292.
[18]	Adamovic T, Willems A, Vanasse M, et al. Critical illness polyneuromyopathy in a child with severe demyelinating myelitis[J/OL]. J Child Neurol, 2009, 24(6): 758-762. https://doi.org/10.1177/0883073808330166.
[19]	丁敏. 儿童重症监护后综合征相关躯体功能障碍对患者出院后再入院和生活质量的影响和随访研究[D]. 吉林大学, 2023.
	Ding M. Impact and follow-up study of physical function impairments associated with post-intensive care syndrome in children on readmission and quality of life after discharge[D]. Jilin University, 2023.
[20]	中华医学会儿科学分会康复学组,中华医学会儿科学分会急救学组. 儿童重症早期康复介入的临床实践指南(2025)[J/OL]. 中华儿科杂志, 2025, 63(5): 454-461. https://doi.org/10.3760/cma.j.cn112140-20241213-00908.
	The Subspecialty Group of Rehabilitation, the Society of Pediatrics, Chinese Medical Association; the Subspecialty Group of Emergency Medicine, the Society of Pediatrics, Chinese Medical Association. Clinical practice guidelines for early rehabilitation intervention in children with critical illness (2025)[J/OL]. Zhonghua Erke Zazhi, 2025, 63(5): 454-461. https://doi.org/10.3760/cma.j.cn112140-20241213-00908.
[21]	Cheung K, Rathbone A, Melanson M, et al. Patho-physiology and management of critical illness polyneuropathy and myopathy[J/OL]. J Appl Physiol (1985), 2021, 130(5): 1479-1489. https://doi.org/10.1152/japplphysiol.00019.2021.
[22]	Swash M, de Carvalho M. Intensive care unit-acquired weakness: neuropathology[J/OL]. J Clin Neurophysiol, 2020, 37(3): 197-199. https://doi.org/10.1097/WNP.0000000000000660.
[23]	Latronico N, Bolton CF. Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis[J/OL]. Lancet Neurol, 2011, 10(10): 931-941. https://doi.org/10.1016/S1474-4422(11)70178-8.
[24]	Friedrich O, Reid MB, Van den Berghe G, et al. The sick and the weak: neuropathies/myopathies in the critically ill[J/OL]. Physiol Rev, 2015, 95(3): 1025-109. https://doi.org/10.1152/physrev.00028.2014.
[25]	Fenzi F, Latronico N, Refatti N, et al. Enhanced expression of E-selectin on the vascular endothelium of peripheral nerve in critically ill patients with neuromuscular disorders[J/OL]. Acta Neuropathol, 2003, 106(1): 75-82. https://doi.org/10.1007/s00401-003-0704-3.
[26]	Stevens RD, Dowdy DW, Michaels RK, et al. Neuro-muscular dysfunction acquired in critical illness: a systematic review[J/OL]. Intensive Care Med, 2007, 33(11): 1876-1891. https://doi.org/10.1007/s00134-007-0772-2.
[27]	Z'Graggen WJ, Lin CS, Howard RS, et al. Nerve excitability changes in critical illness polyneuropathy[J/OL]. Brain, 2006, 129(Pt 9):2461-2470. https://doi.org/10.1093/brain/awl191.
[28]	Bednarik J, Vondracek P, Dusek L, et al. Risk factors for critical illness polyneuromyopathy[J/OL]. J Neurol, 2005, 252(3): 343-351. https://doi.org/10.1007/s00415-005-0654-x.
[29]	王晓敏, 朱晓萍. ICU获得性肌无力的发生和诊断及治疗[J/OL]. 中华危重病急救医学, 2020, 32(8): 1020-1024. https://doi.org/10.3760/cma.j.cn121430-20200709-00505.
	Wang XM, Zhu XP. Occurrence, diagnosis, and rehabilitation of intensive care unit-acquired weakness[J/OL]. Zhonghua Weizhongbing Jijiu Yixue, 2020, 32(8): 1020-1024. https://doi.org/10.3760/cma.j.cn121430-20200709-00505.
[30]	Siu K, Al-Harbi S, Clark H, et al. Feasibility and reliability of muscle strength testing in critically ill children[J/OL]. J Pediatr Intensive Care, 2015, 4(4): 218-224. https://doi.org/10.1055/s-0035-1563544.
[31]	刘子名, 张铁凝, 王丽杰. 床旁超声对危重症患儿肌肉营养状态评估价值的研究进展[J/OL]. 中国小儿急救医学, 2024, 31(12): 929-933. https://doi.org/10.3760/cma.j.issn.1673-4912.2024.12.010.
	Liu ZM, Zhang TN, Wang LJ. Research progress on the value of bedside ultrasound in assessing muscle nutritional status in critically ill children[J/OL]. Zhongguo Xiaoer Jijiu Yixue, 2024, 31(12): 929-933. https://doi.org/10.3760/cma.j.issn.1673-4912.2024.12.010.
[32]	Johnson RW, Ng K, Dietz AR, et al. Muscle atrophy in mechanically-ventilated critically ill children[J/OL]. PLoS One, 2018, 13(12): e0207720. https://doi.org/10.1371/journal.pone.0207720.
[33]	Song J, Deng T, Yu Q, et al. Biomarkers for intensive care unit-acquired weakness: a systematic review for prediction, diagnosis and prognosis[J/OL]. Ann Intensive Care, 2025, 15(1): 86. https://doi.org/10.1186/s13613-025-01500-9.
[34]	李素玲, 李雪莹, 温必清. 集束化管理预防ICU获得性肌无力的护理效果[J/OL]. 临床医学工程, 2019, 26(8): 1141-1142. https://doi.org/10.3969/j.issn.1674-4659.2019.08.1141.
	Li SL, Li XY, Wen BQ. Nursing effect of cluster management in preventing intensive care unit acquired weakness[J/OL]. Linchuang Yixue Gongcheng, 2019, 26(8): 1141-1142. https://doi.org/10.3969/j.issn.1674-4659.2019.08.1141.
[35]	袁梦, 张博, 李倩, 等. 基于行动研究法的早期活动干预在重症患儿中的应用效果[J/OL]. 中华现代护理杂志, 2023, 29(7): 940-944. https://doi.org/10.3760/cma.j.cn115682-20220424-02022.
	Yuan M, Zhang B, Li Q, et al. Effects of early activity based on action research method in severely ill children[J/OL]. Zhonghua Xiandai Huli Zazhi, 2023, 29(7): 940-944. https://doi.org/10.3760/cma.j.cn115682-20220424-02022.
[36]	中华医学会儿科学分会急救学组, 中华医学会急诊医学分会儿科学组, 中华儿科杂志编辑委员会. 中国儿童重症监护病房镇痛和镇静治疗专家共识(2024)[J/OL]. 中华儿科杂志, 2024, 62(3): 196-203. https://doi.org/10.3760/cma.j.cn112140-20231130-00400.
	The Subspecialty Group of Emergency Medicine, the Society of Pediatrics, Chinese Medical Association;the Subspecialty Group of Pediatrics, the Society of Emergency Medicine, Chinese Medical Association; the Editorial Board, Chinese Journal of Pediatrics. Expert consensus on analgesia and sedation for children in pediatric intensive care units of China (2024)[J/OL]. Zhonghua Erke Zazhi, 2024, 62(3): 196-203. https://doi.org/10.3760/cma.j.cn112140-20231130-00400.
[37]	Honarmand K, Sirimaturos M, Hirshberg EL, et al. Society of critical care medicine guidelines on glycemic control for critically ill children and adults 2024:executive summary[J/OL]. Crit Care Med, 2024, 52(4): 649-655. https://doi.org/10.1097/CCM.0000000000006173.
[38]	颜景礼, 许巍. 儿童神经肌肉病的PICU综合治疗[J/OL]. 中国小儿急救医学, 2023, 30(6): 417-421. https://doi.org/10.3760/cma.j.issn.1673-4912.2023.06.004.
	Yan JL, Xu W. Complex treatment of neuromuscular diseases in PICU[J/OL]. Zhongguo Xiaoer Jijiu Yixue, 2023, 30(6): 417-421. https://doi.org/10.3760/cma.j.issn.1673-4912.2023.06.004.
[39]	Tabarki B, Coffinieres A, Van Den Bergh P, et al. Critical illness neuromuscular disease: clinical, electrophysiological, and prognostic aspects[J/OL]. Arch Dis Child, 2002, 86(2): 103-107. https://doi.org/10.1136/adc.86.2.103.

项目	危重病性多发性神经病	危重病性肌病
临床特征	肌力减弱，腱反射减弱或消失。可能出现远端感觉丧失（大/小神经纤维受累）	肌肉明显萎缩，但腱反射正常
神经电生理检查	神经源性损害。①神经传导：CMAPs和SNAPs波幅降低；②肌电图：纤颤电位（急性失神经表现）	肌源性损害。①神经传导：CMAPs波幅降低，感觉神经传导正常；②肌电图：短时限、多相运动单位电位
肌肉/神经活检	神经纤维水肿/肿胀，伴有轴突变性	Ⅱ型肌纤维萎缩。粗肌丝（肌球蛋白）丢失（特征性但非总是可见）

儿科重症监护病房获得性肌无力的研究进展

Research progress of pediatric intensive care unit-acquired weakness

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