大剂量静脉滴注人免疫球蛋白联合机械通气治疗小儿重型吉兰-巴雷综合征的临床与电生理研究

Clinical and electrophysiological study of high-dose intravenous drip of human immunoglobulin combined with mechanical ventilation in the treatment of severe Guillain-Barre syndrome in children

目的观察大剂量静脉滴注人免疫球蛋白静脉滴注冲击疗法联合机械通气治疗小儿重型吉兰-巴雷综合征的临床效果以及神经与肌肉的电生理改变。方法选取34例重型吉兰-巴雷综合征患儿,均给予常规治疗+大剂量静脉滴注人免疫球蛋白冲击疗法联合机械通气治疗,对临床效果,尤其是神经与肌肉的电生理改变进行观察。结果治疗后患儿神经功能临床评分较治疗前明显降低,正中神经、腓神经、尺神经及胫神经传导速度较治疗前明显增加(P<0.05);治疗后患儿肌电检查异常率较治疗前明显降低,失神经电位较治疗前有明显变化,运单位电位募集型较治疗前单纯型和病理电静息型明显减少,干扰波减少和完全干扰型明显增多(P<0.05)。患者四肢无力、肌张力恢复、呼吸肌麻痹、腱反射恢复、四肢疼痛、感觉障碍时间均较短。治疗后有1例患儿无自主呼吸,撤机困难,家长放弃治疗,最终死亡。结论采取机械通气联合免疫球蛋白治疗小儿重型吉兰-巴雷综合征患儿,临床效果明显,能有效缩短病程,改善神经损伤。

Objective To investigate the clinical effect and electrophysiological changes of intravenous drip of human immunoglobulin combined with mechanical ventilation nerves and muscles in children with severe Guillain-Barre syndrome treated by high-dose intravenous drip of human immunoglobulin combined with mechanical ventilation. Methods Selection of 34 patients with severe Guillain-Barre syndrome. All the patients were treated with routine treatment, pulse therapy with high-dose intravenous immunoglobulin(IVIG) and mechanical ventilation. Observation of clinical efficacy, especially neurological function. Results After the treatment, the clinical score of nerve function in the patient was significantly lower than before the treatment, and the conduction speed of the median nerve, fibular nerve, ulnar nerve, limb pain and tibial nerve was significantly higher than before the treatment( P < 0.05). After treatment, the abnormal rate of myoelectric examination was significantly lower than before treatment, and the loss of nerve potential was significantly different before treatment. The transport unit potential raising type significantly decreased the pure type and pathological electrostatic type, the interference wave decreased, and the total interference type increased significantly compared to the pre-treatment( P < 0.05). Patients with limb weakness, muscle tension recovery, respiratory paralysis, tendon reflex recovery, and sensory disorders use time are all shorter. After treatment, there was one patient who had no autonomous breathing, had difficulty withdrawing, and parents gave up treatment and eventually died. Conclusion The combined mode of mechanical ventilation and IVIG can remarkably increase the clinical efficacy, shorten the course of the disease and improve the nerve damage. It is worthy of clinical promotion.