合并呼吸衰竭的吉兰-巴雷综合征48例临床、电生理研究

Evaluation of clinical and neurophysiological features in 48 patients with respiratory failure in Guillain-Barré syndrome

目的研究合并呼吸衰竭的吉兰-巴雷综合征(Guillain-Barr syndrome,GBS)患者的临床及电生理特征。方法收集1999年至2005年在中南大学湘雅二医院住院治疗的134例GBS患者,按患者是否合并呼吸衰竭而分为2组,分别比较其临床及电生理特征。结果呼吸衰竭组与非呼吸衰竭组临床特征比较,患者的年龄、性别、前驱事件(包括上呼吸道感染、发热、腹泻)无统计学差异(P>0.05),而在病情达高峰的时间、合并球麻痹、双侧面瘫、自主神经功能障碍方面有统计学差异(P<0.05);比较两组患者的电生理特征发现,复合肌肉动作电位(com-pound muscle action potential,CMAP)波幅降低、肌电图(electromyography,EMG)失神经电位方面有统计学差异(P<0.05);呼吸衰竭组中有4例患者轴索损害和脱髓鞘改变合并存在;Logistic回归分析显示病情达高峰的时间以及球麻痹症状为合并呼吸衰竭GBS患者的危险因素。结论病情较快达高峰、合并球麻痹对GBS患者合并呼吸衰竭具有预测价值。

Objective To investigate clinical and neurophysiological features of GBS patients with respiratory failure. Methods All 134 cases of patients with GBS admitted to Second Xiangya Hospital of Central South University from 1999 to 2005 were erolled, and were divided into two groups with or without respiratory failure. The clinical and neurophysio- logical features were analysised. Results Comparing the clinical data of two groups, age, gender and preceding affairs （ inelude upper infection, fever, diarrhea） are not of significant difference （ P 〉 0.05 ）. While time to peak disability, bulbar paralysis, biracial weakness and autonomic dysfunction are of significant differencel （P 〈 0. 05 ）. Comparing the neurophysiological features, decent of CMAP wave amplitude and denervation potential are of significant difference（ P 〈 0. 05 ）. A combination of axonopathic and demyelinating GBS was seen in 4 patients in group with respiratory failure. Multiple logistic regression suggests early progression to peak disability and bulbar dysfunction are risk factors of respiratory failure in GBS. Conclusions Early progression to peak disability, bulbar dysfunction were suggested as predictors of respiratory failure in GBS.