血浆置换治疗极重型格林-巴利综合征临床分析

Treatment of plasma exchange on the most severe Guillain-Barre syndrome

目的探讨血浆置换对极重型格林-巴利综合征的治疗作用。方法回顾性分析2003年以来我院重症医学科极收治的重型格林-巴利综合征23例临床资料,并将其分成两组:其中2003年1月～2009年4月治疗的18例为大剂量静脉输注免疫球蛋白组(IVIG),2009年5月～2010年6月治疗的5例为血浆置换组(PE)。比较观察两组患者机械通气时间、ICU住院时间、总住院时间、肌力改善Ⅰ级平均时间、临床干预距离发病平均时间以及气管切开构成比例等指标。结果 PE组患者机械通气时间、肌力改善Ⅰ级平均时间、ICU住院时间及总住院时间均显著低于IVIG组,组间比较均有显著统计学意义(P≤0.001);气管切开构成比PE组低于IVIG组,两组比较有统计学意义(P=0.011),而两组间临床干预距离发病平均时间比较差异无统计学意义(P=0.554)。结论血浆置换治疗格林-巴利综合征起效快,它能缩短格林-巴利综合征严重症状持续期,缩短其病程,疗效优于静脉大剂量输注免疫球蛋白,值得临床应用推广。

Objective To investigate the effects of plasma exchange on the most severe Guillain-Barre syndrome.Methods The clinical data of 23 cases of the most severe Guillain-Barre syndrome in department of critical care medicine of our hospital since 2003 were studied retrospectively,and they were divided into two groups.One group was for the treatment of 18 patients with high-dose intravenous immune globulin （IVIG） from January 2003 to April 2009,the other was for the treatment of 5 cases of plasma exchange （PE） from May 2009 to June.Comparison of two groups of patients with the duration of mechanical ventilation,ICU length of stay,total hospital stay,the average time to improve muscle strength grade Ⅰand from onset to clinical intervention and difference of constitute of tracheotomy were observed.Results The duration of mechanical ventilation,the average time for muscle strength to improve the grade Ⅰ,ICU length of stay and total hospital stay in patients with PE group were evidently lower than those with IVIG group,there were statistically significant difference（P≤0.001）;constituent ratio of tracheotomy in PE group was obviously lower than that in IVIG group （P= 0.011）.But the average time from onset to clinical intervention showed no difference between two groups （P= 0.554）.Conclusion Treatment of plasma exchange on Guillain-Barre Syndrome works immediately,which can shorten the duration of severe symptoms of Guillain-Barre syndrome and the course of its disease.A more effective treatment than that with high-dose intravenous immunoglobulin,it is worthy of clinical application and popularization.