目的:本研究的目的是检查呈现,损伤模式,和临床课程,机械通气后COVID-19相关的周围神经损伤。
方法:对需要机械通气的COVID-19并发ARDS患者进行多中心回顾性研究。患者记录被审查为ICU和插管特征,俯卧或侧卧定位,和神经病的诊断。
结果:在2020年9月至2022年1月之间,有11例患者被诊断为周围神经病变,包括9例COVID-19感染后的臂丛神经病变。每位患者出现需要机械通气的ARDS的中位数为39天。6例患者(54.5%)进行了俯卧定位和1例侧卧位。神经病涉及5种臂丛神经病变,2不完全臂丛神经病变,2下躯干神经丛病变,1个放射状神经病,双侧尺神经病变1例。平均随访10.2个月,臂丛神经病变患者在近端表现出神经支配的迹象,一个人解决了放射状单神经病;然而,大多数已显示最小的临床改善.
结论:我们的系列研究表明,在ARDS相关的COVID-19感染的机械通气后,已诊断出周围神经病变,尤其是臂丛神经病变。与之前的COVID-19研究相反,这些患者中只有54.5%进行俯卧位.除了易位造成的创伤性干扰,神经病变的发生率增加可能涉及COVID-19通过直接侵入神经的无创作用,自身抗体靶向神经组织,或高凝引起的微血栓性血管病。
The purpose of the study is to examine presentation, injury patterns, and clinical course, for COVID-19-related peripheral nerve injury following mechanical ventilation.
A multicenter retrospective study of patients with COVID-19 complicated by acute respiratory distress syndrome (ARDS) that required mechanical ventilation was undertaken. Patient records were reviewed for intensive care unit and intubation characteristics, prone or lateral decubitus positioning, and the onset of neuropathy diagnosis.
Between September 2020 and January 2022, 11 patients were diagnosed with peripheral neuropathy, including 9 with brachial plexopathy following COVID-19 infection. Each patient developed ARDS requiring mechanical ventilation for a median of 39 days. Six patients (54.5%) underwent prone positioning and 1 lateral decubitus. Neuropathies involved 5 brachial pan-plexopathies, 2 incomplete brachial plexopathies, 2 lower trunk plexopathies, 1 radial neuropathy, and 1 bilateral ulnar neuropathy. At a mean follow-up of 10.2 months, patients with brachial pan-plexopathies demonstrated signs of reinnervation proximally, and 1 resolved to a radial mononeuropathy; however, the majority have demonstrated minimal clinical improvements.
Our series demonstrates that peripheral neuropathies and especially brachial plexopathies have occurred following mechanical ventilation for ARDS-related COVID-19 infections. Contrary to prior COVID-19 studies, only 54.5% of these patients underwent prone positioning. Aside from a traumatic disturbance of prone positioning, the increased incidence of neuropathy may involve an atraumatic effect of COVID-19 via direct invasion of nerves, autoantibody targeting of nervous tissue, or hypercoagulation-induced microthrombotic angiopathy.