重症肌无力患者病情复发或加重的影响因素分析

Multivariate Analysis of Recurrence or Exacerbation for Patients with Myasthenia Gravis

目的明确在非住院环境下和住院环境下影响重症肌无力患者病情复发或加重的危险因素,并提出相应的护理措施。方法采用横断面观察和前瞻性描述性观察结合的设计,收集住院部和门诊部患者社会学资料、疾病特征、症状和体征共3个方面30个影响因素资料,对横断面观察和前瞻性描述性观察的数据独立分析,分别探索针对各自结局的独立危险因素。结果共329例患者进入横断面观察分析,其中复发或加重158例;167例患者进入前瞻性描述性观察分析,其中复发或加重18例。多因素分析结果显示感染史(OR=4.564,95%CI:32.288～285.362)、用药不当(OR=1.855,95%CI:2.945～13.878)、身体异常(OR=1.874,95%CI:2.915～14.565)、过度劳累(OR=1.864,95%CI:2.983～13.932)共4个变量是影响非住院环境下重症肌无力患者病情复发或加重的独立危险因素;感染史(OR=2.619,3.054～61.632)、精神创伤(OR=2.684,2.831～75.710)2个变量是影响住院环境下重症肌无力患者病情复发或加重的独立危险因素。结论影响非住院环境下重症肌无力患者病情复发或加重的独立危险因素有感染、用药不当、过度劳累、身体异常,影响住院环境下重症肌无力患者病情复发或加重的独立危险因素有感染、情志创伤,在临床中应注意积极预防和管理上述各种危险因素。

Objective To identify the independent risk factors of recurrence or exacerbation for patients with myasthenia gravis（MG） and propose corresponding nursing measures.Methods The combination design of cross-sectional study and prospective descriptive study was adopt.Data including 30 variables affiliated to demographic characteristics,disease characters and symptoms and signs sections collected from the patients diagnosed as MG was analyzed.Then,the independent analyses of cross-sectional study and prospective descriptive study were performed respectively.Results Of the total,158 and 18 patients were in adverse outcome respectively.In the multivariate analyses,four independent predictive factors were correlated with adverse outcome in non-hospitalization group： infection（OR： 4.564,95%CI： 32.288～285.362）,inappropriate treatment（OR： 1.855,95%CI： 2.945～13.878）,body discomfort（OR： 1.874,95%CI： 2.915～14.565） and excessive fatigue（OR： 1.864,95%CI： 2.983～13.932）;two independent predictive factors were correlated with adverse outcome in hospitalization group： infection（OR： 2.619,95%CI： 3.054～61.632） and emotion depress（OR： 2.684,95%CI： 2.831～75.710）.Conclusion Infection,inappropriate treatment,excessive fatigue and body discomfort are independent risk factors related with recurrence or exacerbation of MG in non-hospitalization.Infection and emotion depress are independent risk factors related with recurrence or exacerbation of MG in hospitalization.More attention should be attached to these risk factors in disease prevention and clinical administration.