摘要
目的：分析中西医结合治疗重症肌无力危象的疗效。方法：１０例重症肌无力危象患者及时经鼻气管插管、呼吸机辅助正压通气，意识不清者，采用控制通气呼吸模式；意识清楚者，采用同步间隙指令呼吸（ＳＩＭＶ）加压力支持通气（ＰＳＶ）。并应用大剂量类固醇激素，对有激素禁忌证者静滴大剂量丙种球蛋白，对感染触发危象或危象后伴发感染者，积极选用抗生素，同时中药治以回阳救逆、扶正纳气、肃肺化痰治疗；同时进行了乙酰胆碱受体抗体、肺功能、食管运动功能等项检测。结果：抢救成功７例，死亡３例，危象病死率３０％。８例检测乙酰胆碱受体抗体平均为４．５２±１．６８，与同期无危象的重症肌无力组（１．１８±１．０２）比较有显著性差异（ｔ＝８．２，Ｐ＜０．０１）。肺功能检测：１０例患者均提示有中至重度肺容量受限。食管运动功能检测９例中８例异常。结论：及时建立呼吸通道给予呼吸机控制呼吸是保证抢救成功的首要步骤；充分关注和及时处置感染和心脏并发症；肌无力危象病死率的高低与危象救治是否及时、并发症的严重程度、呼吸机的掌握与合理使用、激素及其它免疫调节剂的应用以及综合措施的得力与否有关。
Objective:To analyze the therapeutic efficacy of TCM WM on myasthenia gravis (MG)crisis.Methods:Ten cases of MG crisis were treated with endotracheal intubation via nose,positive pressure ventilation(PPV),control ventilation pattern for unconscious,simultanous intermittent mechanical ventilation(SIMV) and pressure support ventilation(PSV) for conscious subjects.In addition,a high doses of steroid hormone were given;intravenous drip γglobulin for cases with contraindication to steroid hormone;suitable antibiotics were given for crisis induced by infection or crisis accompanied by infection.At the same time,they were treated with TCM recipes including Huiyang Jiuni,Fuzheng Naqi ,Sufei Huatan etc.Then,to detect the acetycholin receptor antibody,pulmonary function and esophageal movement ability.Results:Seven cases were survied,3 cases were died,the mortality of crisis was 30%.The acetycholin receptor antibody in 8 cases were 452±168 and 118±102 in MG patients with crisis and without crisis respectively,it was obvius difference between with and without crisis patients (t=82,P<001).The lung capacity was limited moderately or severely in all 10 patients;the esophageal movement ability was abnormal in 8 cases among 9 cases.Conclusions:To set up the respiratory passage way and control breath via ventilator were a primary step for saving successfully;it was important to treat infection and cardiac complication timely.The related factors that influencing mortality were dependent upon treating crisis timely,severity of complication,using ventilator reasonably.administrating hormone and immuno regulator as well as complex management.Moreover,TCM WM treating MG crisis could reveal better effect.
