血气监测指导药物滴定治疗重症肌无力危象1例  

The myasthenia gravis crisis with titration therapy guided by blood gas monitoring:a case report

作　　者：王金萍 王满侠[1] Wang Jinping;Wang Manxia(The Second Hospital&Clinical Medical School,Lanzhou University,Lanzhou 730030,Gansu,China)

机构地区：[1]兰州大学第二医院(第二临床医学院),甘肃兰州730030

出　　处：《生物医学转化》2023年第4期81-85,共5页Biomedical transformation

基　　金：甘肃省自然科学基金项目(20YF8WA087);甘肃省中医药科研重点课题(GZKZ-2021-9);兰州大学第二医院萃英科技创新计划项目(CY2022-MS-A17)。

摘　　要：重症肌无力(Myasthenia Gravis,MG)是一种以神经肌肉接头处突触后膜功能障碍为特征的自身免疫性疾病,该病以肌肉疲劳和无力为特征,其主要抗原靶点为乙酰胆碱受体(Acetylcholine Receptor,AChR)。当累及膈肌等呼吸肌引起呼吸衰竭需要有创或无创通气时称之为肌无力危象(Myasthenic Crisis,MC),通气不足引起CO_(2)大量潴留、PCO_(2)升高及颅内压升高,进而导致意识障碍。因此,及时监测动态血气并采取精确治疗显得尤为重要。滴定抗胆碱酯酶剂治疗的目的是为药物转化提供合适的剂量,处理好“剂末现象”,为危象患者呼吸功能好转后提供更好的脱机条件。本文报道1例因感染引起吞咽困难、呼吸困难及意识障碍的抗AChR抗体阳性的重症肌无力危象患者,经动态监测血气、呼吸机辅助通气、控制感染及滴定抗胆碱酯酶药物治疗后好转出院。Myasthenia gravis(MG)is an autoimmune disease characterized by postsynaptic membrane dysfunction at the neuromuscular junction.It is characterized by muscle fatigue and weakness,and its main antigen target is acetylcholine receptor(AChR).When respiratory failure caused by involved respiratory muscles such as the diaphragm requires invasive or non-invasive ventilation,it is called myasthenia crisis(MC).Inadequate ventilation can lead to massive retention of CO_(2),elevated PCO_(2) and increased intracranial pressure,which lead to disturbance of consciousness.Therefore,it is particularly important to monitor dynamic blood gas in time and take accurate treatment.The purpose of titration anticholinesterase treatment is to provide an appropriate dose for drug conversion,to deal with the“end-of-dose of drug phenomenon”well,and to provide better weaning conditions for crisis patients after their respiratory function have taken a turn for the better.This article reported a case of MC patient with positive anti-AChR antibody who suffered from the dysphagia,the dyspnea,and disturbance of consciousness caused by infection.After dynamically monitoring of blood gas analysis,mechanical ventilation,controlling infection and titration of anti-cholinesterase drugs were given,the patient had improved and discharged.

关 键 词：重症肌无力 重症肌无力危象 动脉血气分析 滴定治疗 

分 类 号：R746.1[医药卫生—神经病学与精神病学]