【摘要】：目的分析重癥吉蘭巴雷綜合征(GBS)患者機械通氣及出院6個月預(yù)后的影響因素,為臨床治療提供幫助。方法回顧性分析2009-01-01至2015-12-31首都醫(yī)科大學(xué)宣武醫(yī)院神經(jīng)重癥監(jiān)護病房(NCU)收治的50例重癥GBS患者的臨床資料。分別收集免疫治療前、出NCU時、出院6個月所有患者的GBS殘障量表(H-GBSDS)評分,按照是否進行機械通氣、治療效果是否良好、出院6個月預(yù)后是否良好進行分類,并分析性別、年齡、發(fā)病前感染性誘因情況、發(fā)病至入院時間、顱神經(jīng)受累情況、自主神經(jīng)功能障礙情況、肌電圖表現(xiàn)為軸索型損害+混合型損害情況對重癥GBS患者是否進行機械通氣的影響;上述因素以及發(fā)病至免疫治療時間對重癥GBS患者治療效果的影響;上述因素以及機械通氣情況、免疫球蛋白(IVIG)治療1個療程情況、治療效果、低蛋白血癥情況、低鈉血癥情況、住NCU時間對重癥GBS患者出院6個月預(yù)后的影響。結(jié)果 50例重癥GBS患者中,住院期間死亡2例,隨訪過程中失訪7例,最終完成出院6個月隨訪41例,其中63.4%(26/41)預(yù)后良好。進行機械通氣的重癥GBS患者自主神經(jīng)功能障礙率高于未進行機械通氣的重癥GBS患者(P0.05);治療效果良好的重癥GBS患者發(fā)病前有感染性誘因率高于治療效果不良的重癥GBS患者(P0.05);出院6個月預(yù)后良好的重癥GBS患者治療效果良好率高于出院6個月預(yù)后不良的重癥GBS患者,住NCU時間短于出院6個月預(yù)后不良的重癥GBS患者(P0.05)。多因素Logistic回歸分析結(jié)果顯示,自主神經(jīng)功能障礙是重癥GBS患者是否進行機械通氣的獨立影響因素[OR=5.573,95%CI(1.027,30.242),P0.05];發(fā)病前有感染性誘因是重癥GBS患者治療效果的獨立影響因素[OR=4.743,95%CI(1.003,22.442),P0.05];治療效果、住NCU時間是重癥GBS患者出院6個月預(yù)后的獨立影響因素[OR=59.720,95%CI(4.411,809.698),P0.05;OR=1.069,95%CI(1.007,1.135),P0.05]。結(jié)論存在自主神經(jīng)功能障礙的重癥GBS患者需要機械通氣概率更大;發(fā)病前有感染誘因較無感染誘因的重癥GBS患者治療效果良好;早期治療效果良好的重癥GBS患者出院6個月預(yù)后良好,而住NCU時間長的GBS患者出院6個月預(yù)后不良;重癥GBS患者經(jīng)過積極治療,絕大多數(shù)預(yù)后良好。
[Abstract]:Objective to analyze the influencing factors of mechanical ventilation and 6 months' discharge in patients with severe Guillain Barre syndrome (GBS). Methods the clinical data of 50 patients with severe GBS admitted to (NCU) in Neurointensive Care Unit of Xuanwu Hospital of Capital Medical University from 01 to 2015 to 31 were analyzed retrospectively. the clinical data of 50 patients with severe GBS treated in intensive care unit of Xuanwu Hospital of Capital Medical University were analyzed retrospectively. The GBS disability scale (H-GBSDS) scores of all patients were collected before and after NCU, and classified according to whether mechanical ventilation was performed, whether the treatment effect was good or not, and whether the prognosis was good at 6 months after discharge. Sex, age, infectious inducement before onset, time from onset to admission, craniocerebral nerve involvement and autonomic nerve dysfunction were analyzed. Electromyography showed the effect of axonal damage on mechanical ventilation in patients with severe GBS. The above factors and the effect of onset to immunotherapy time on the therapeutic effect of severe GBS patients, the above factors and mechanical ventilation, immunoglobulin (IVIG) treatment for one course of treatment, therapeutic effect, hyponatremia, NCU stay time on the prognosis of severe GBS patients after 6 months of discharge. Results of the 50 patients with severe GBS, 2 died during hospitalization and 7 lost their follow-up during the follow-up. 41 patients were followed up for 6 months after discharge, of which 63.4% (26 鈮，

本文編號：2506796