16例危重型吉兰-巴雷综合征临床分析  

Clinical analysis of 16 cases of critically ill Guillain-Barrésyndrome

作　　者：王虹富 张哲林[2] 杨艳泽 WANG Hongfu;ZHANG Zhelin;YANG Yanze(Bayannur Hospital,Bayannur 015000,China;Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010059,China)

机构地区：[1]巴彦淖尔市医院,内蒙古巴彦淖尔015000 [2]内蒙古医科大学附属医院,内蒙古呼和浩特010059

出　　处：《中国实用神经疾病杂志》2022年第10期1232-1235,共4页Chinese Journal of Practical Nervous Diseases

摘　　要：目的分析危重型吉兰-巴雷综合征患者的临床特点。方法纳入2010-01—2020-12在内蒙古医科大学附属医院、巴彦淖尔市医院住院治疗且需有创通气的16例吉兰-巴雷综合征患者,对患者的年龄、性别、职业、前驱病史、首发症状、发病至高峰时间、脑神经受累情况、肌电图、实验室检查指标、治疗及预后进行回顾性分析。结果青年(18~40岁)2例,中年(41~65岁)10例,老年(≥66岁)4例;男女比例为15∶1;农民8例,工人2例,自由职业4例,企业管理人员2例;发病前有明显诱因11例,无明显诱因5例;单纯以肢体无力、麻木为首发症状10例,肢体无力合并言语不清、进食水呛咳起病6例;16例患者腱反射减退或消失;发病至症状达到高峰时间(需要机械通气)时间波动在18 h~7 d;12例(75%)脑神经受损;完成肌电图例检查12例,8例轴索型,4例脱髓鞘型;脑脊液蛋白-细胞分离10例,5例未做,1例无蛋白-细胞分离。所有患者接受免疫球蛋白联合激素冲击治疗,10例出院时呼吸肌功能恢复,脱离呼吸机,日常活动能力丧失,2例死亡,4例放弃治疗;10例出院时呼吸肌功能恢复患者住院时间1~3个月。结论吉兰-巴雷综合征患者大部分发病前存在呼吸道感染或腹泻史,急性危重型吉兰-巴雷综合征多见于中年男性体力劳动者,多存在脑神经损伤,特别是合并舌咽迷走神经损伤患者,肌电图以轴索损害为主。经过正规治疗,疗程>1个月的大部分患者可以脱离呼吸机。Objective To analyze the clinical characteristics of critically ill patients with Guillain-Barre syndrome.Methods From January 2010 to December 2020,16 patients with Guillain-Barre syndrome who were hospitalized in the Affiliated Hospital of Inner Mongolia Medical University and Bayannur Hospital and required invasive ventilation were collected.The patients’age,gender,occupation,prodromal history,first symptoms,onset to peak time,cranial nerve involvement,electromyography,laboratory test indicators,treatment and prognosis were observed and analyzed retrospectively.Results Two cases were young(18-40 years old),10 were middle-aged(41-65 years old),and 4 were elderly(≥66 years old).The ratio of male to female was 15:1.There were 8farmers,2 workers,4 freelancers,and 2 enterprise managers.There were 11 cases with obvious incentives before the onset,and 5 cases without obvious incentives.Only 10 cases with limb weakness/numbness as the first symptom.Six cases of limb weakness combined with slurred speech/choking on food and water.Tendon reflexes decreased or disappeared in 16 patients.The time from onset to peak symptoms(requiring mechanical ventilation)fluctuates from 18 hours to 7 days.Cranial nerve damage was present in 12 cases(75%).Completed electromyography in 12 cases,8 cases of axonal type and 4 cases of demyelination type.Cerebrospinal fluid protein cell separation was performed in 10 cases,5 cases were not done,and 1 case was without protein cell separation.All patients received immune globulin combined with hormone pulse therapy.At the time of discharge,10 patients recovered their respiratory muscle function and were released from the ventilator and lost their ability to perform daily activities.Two died and 4 gave up treatment.The hospitalization days of the 10 patients with recovery of ventilator function at discharge were 1 month to 3 months.Conclusion Gillain-Barre syndrome has a history of respiratory tract or diarrhea before the onset of the disease.Acute critical Guillain-Barre syndrome is more co

关 键 词：吉兰-巴雷综合征 机械通气 临床特点 脑神经损伤 轴索损害 预后 

分 类 号：R745[医药卫生—神经病学与精神病学]