血浆净化治疗格林-巴利综合征临床疗效分析

The clinical effect of plasmapheresis for Guillain-Barre syndrome

目的观察血浆净化(plasmapheresis,PP)在格林-巴利综合征(Guillain-Barresyndrome)(GBS)患者中的临床疗效,初步探讨不同净化方法疗效的比较。方法回顾1998～2004年6年间在中日友好医院神经内科住院的GBS患者38例的临床资料,所有病例均符合GBS诊断标准。PP治疗组23例,男18例,女5例,年龄15～76岁,平均(39.95±16.66)岁;非PP治疗组15例,男11例,女4例,年龄20～70岁,平均(44.07±14.70)岁。两组患者按Hughes分类进行分级。每次处理血浆量为1～2个血浆容量。观察治疗前后临床症状及肌力的改善程度,减少1个Hughes等级为GBS临床改善。结果疗效及转归:PP组患者进步1级的日数平均为(10.83±9.38)天,而非PP组为(32.13±11.30)天,P<0.01。呼吸机辅助呼吸者,PP组持续7天,而非PP组则持续18天。PP组死亡1例,非PP组无死亡。PP组23例中,单重血浆置换(PE)16例,双重血浆置换(DFPP)4例,血浆吸附(PA)3例;16例PE者进步1级的平均日数为11.44天;4例DFPP者进步1级的平均日数为7.25天;3例PA者进步1级的平均日数为12.33天。并发症:PP治疗84例次,发生不良反应13例次,发生率15.5%。PE治疗57例次,9例次出现不同程度的口周及四肢麻木、荨麻疹、寒战、发热和低血压等;DFPP治疗16例次,4例次发生血压下降;PA治疗11例次,无并发症发生。结论PP治疗能够迅速缓解GBS患者的临床症状,可显著缩短病程以及使用人工呼吸的间期,改善患者预后。不同方法并发症的发生明显不同,PE治疗并发症较多,DFPP和PA治疗并发症少。治疗方法上尽量寻求效果相当、并发症少而且费用较低者。

Obiective To observe clinical effect of plasmapheresis （PP） for Guillain- Barre syndrome and compare different methods, provid theory and practice experience for application of PP. Methods Thirty-eight patients with Guillain-Barre syndrome hospitalized during 1998-2004 were retrospectively reviened, There were 23 cases （18 male and 5 female）in PP group, age ranged from 15 to 16 years, mean age was （39.95±16.66） years. Other 15 cases （11 male and 4 female） were in non-PP group, age ranged form 20 to 70 years, mean age was （44. 07± 14.70）years. Baseline characteristics of the patients in two group were well matched. Patients were evaluated. According to Hughes classification, every treatment exchanged 1-2 the patient＇s estimated plasma volume. Clinical symptoms and muscle tensility prior- and post treatment were evaluated. Results The average days to improve 1 grade of hughes classification in PP group was statistically different with that in non-PP group [（10. 83±9.38） vs （32. 13±11.30）,P〈0. 01）]. The period of ventilatory support was 7 days in PP group and 18 days in non-PP group. One patient died in PP group and no case died in non-PP. Group of 23 cases in PP group, 16 cases were performed by the plasma exchange （PE）,4 eases by the double filtration plasmapheresis（DFPP）, and 3 cases by the plasma adsorption（PA）,a nd the average days to improve 1 grade were 11.44 days, 7.25 days and 12.33 days respectively. Total 84 procedures in PP group, in 13 procedures occurred adverse effect（15.5%）.Of the 57 procedures in PE patients, in 9 procedures occurred adverse effect, include a mouth and limbs anesthesia, urticaria, chill, fever and hypotension;4 procedures of 16 procedures in DFPP patients occurred hypotension; no complication occurred in PA（11 procedures）. Conclusions PP treatment could relief clinical symptoms of 6Bb patient rapidly, significantly, shorten the course of disease and the period of ventilatory support, and improve the prognosis of GBS patient. Compared with PE, DFPP and PA, the incidence of complications of PE was the highest. An effective method, low-cost and minimal complication procedure should be selected.