静脉注射免疫球蛋白与血浆置换治疗机械通气患儿格林-巴利综合征的随机对照研究。
Comparison of intravenous immunoglobulin and plasma exchange in treatment of mechanically ventilated children with Guillain Barré syndrome: a randomized study.
机构信息
Pediatric Intensive Care Unit, Mansoura University Children Hospital, Al-Gomhuria Street, Mansoura 35516, Egypt.
出版信息
Crit Care. 2011 Jul 11;15(4):R164. doi: 10.1186/cc10305.
INTRODUCTION
Respiratory failure is a life threatening complication of Guillain Barré syndrome (GBS). There is no consensus on the specific treatment for this subset of children with GBS.
METHODS
This was a prospective randomized study to compare the outcome of intravenous immunoglobulin (IVIG) and plasma exchange (PE) treatment in children with GBS requiring mechanical ventilation. Forty-one children with GBS requiring endotracheal mechanical ventilation (MV) within 14 days from disease onset were included. The ages of the children ranged from 49 to 143 months.Randomly, 20 children received a five-day course of IVIG (0.4 g/kg/day) and 21 children received a five-day course of one volume PE daily. Lumbar puncture (LP) was performed in 36 patients (18 in each group).
RESULTS
Both groups had comparable age (p = 0.764), weight (p = 0.764), duration of illness prior to MV (p = 0.854), preceding diarrhea (p = 0.751), cranial nerve involvement (p = 0.756), muscle power using Medical Research Council (MRC) sum score (p = 0.266) and cerebrospinal fluid (CSF) protein (p = 0.606).Children in the PE group had a shorter period of MV (median 11 days, IQR 11.0 to 13.0) compared to IVIG group (median 13 days, IQR 11.3 to 14.5) with p = 0.037.Those in the PE group had a tendency for a shorter Pediatric Intensive Care Unit (PICU) stay (p = 0.094).A total of 20/21 (95.2%) and 18/20 (90%) children in the PE and IVIG groups respectively could walk unaided within four weeks after PICU discharge (p = 0.606).There was a negative correlation between CSF protein and duration of mechanical ventilation in the PE group (p = 0.037), but not in the IVIG group (p = 0.132).
CONCLUSIONS
In children with GBS requiring MV, PE is superior to IVIG regarding the duration of MV but not PICU stay or the short term neurological outcome.The negative correlation between CSF protein values and duration of MV in PE group requires further evaluation of its clinical usefulness.
TRIAL REGISTRATION
Clinicaltrials.gov Identifier NCT01306578.
介绍
呼吸衰竭是吉兰-巴雷综合征（GBS）的一种危及生命的并发症。对于这组需要机械通气的儿童，尚无关于静脉注射免疫球蛋白（IVIG）和血浆置换（PE）治疗的具体共识。
方法
这是一项前瞻性随机研究，比较了静脉注射免疫球蛋白（IVIG）和血浆置换（PE）治疗需要机械通气的吉兰-巴雷综合征（GBS）儿童的结果。纳入了 41 名在疾病发作后 14 天内需要气管内机械通气（MV）的 GBS 儿童。儿童年龄为 49 至 143 个月。随机选择 20 名儿童接受为期 5 天的 IVIG（0.4 g/kg/天）治疗，21 名儿童接受为期 5 天的每天一次的 PE 治疗。36 名患者（每组 18 名）进行了腰椎穿刺（LP）。
结果
两组的年龄（p = 0.764）、体重（p = 0.764）、MV 前疾病持续时间（p = 0.854）、前腹泻（p = 0.751）、颅神经受累（p = 0.756）、肌肉力量（使用医学研究委员会（MRC）总分评分（p = 0.266）和脑脊液（CSF）蛋白（p = 0.606）均相似。PE 组的 MV 时间较短（中位数 11 天，IQR 11.0 至 13.0），IVIG 组（中位数 13 天，IQR 11.3 至 14.5），p = 0.037。PE 组的儿科重症监护病房（PICU）停留时间有缩短趋势（p = 0.094）。PE 和 IVIG 组分别有 20/21（95.2%）和 18/20（90%）名儿童在 PICU 出院后四周内能够独立行走（p = 0.606）。PE 组 CSF 蛋白与机械通气时间之间存在负相关（p = 0.037），但 IVIG 组无此相关性（p = 0.132）。
结论
对于需要 MV 的 GBS 儿童，PE 组在 MV 持续时间方面优于 IVIG 组，但在 PICU 住院时间或短期神经预后方面无差异。PE 组 CSF 蛋白值与 MV 持续时间之间的负相关关系需要进一步评估其临床应用价值。
试验注册
Clinicaltrials.gov 标识符 NCT01306578。
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