Emerg Med J. 2011 Aug;28(8):709-11. doi: 10.1136/emj.06.2010.3091rep.
A 67-year-old man presented to the acute medical take with a history of droopy eyelids and difficulty swallowing. A diagnosis of myasthenia gravis was suspected from the clinical history. The patient's symptoms were progressive, raising concerns of aspiration pneumonia or respiratory compromise if untreated. Definitive diagnosis of myasthenia gravis relies upon a combination of serological and electrophysiological investigations, the results of which are not immediately available in an acute situation. Bedside tests are therefore of practical clinical importance to enable prompt and effective initiation of treatment, particularly where critical symptoms are present. The ice-test is a straightforward and non-invasive investigation with a high sensitivity for myasthenia gravis and is a useful alternative to edrophonium testing. It is especially helpful in patients with cardiac and respiratory co-morbidities for whom acetylcholinesterase inhibitors are contraindicated. We describe a case where this simple bedside test successfully expedited the correct treatment and improved patient care.
一位 67 岁男性因眼睑下垂和吞咽困难到急性内科就诊。根据临床病史，怀疑患有重症肌无力。患者的症状逐渐加重，如果不治疗，有发生吸入性肺炎或呼吸功能障碍的风险。重症肌无力的明确诊断依赖于血清学和电生理学检查的综合结果，而在急性情况下这些结果无法立即获得。床边检查因此在实际临床中具有重要意义，能够及时有效地开始治疗，特别是在存在危急症状的情况下。冰试验是一种简单且无创的检查，对重症肌无力具有很高的敏感性，是进行依酚氯铵试验的一种有用替代方法。对于存在心脏和呼吸合并症的患者，乙酰胆碱酯酶抑制剂被禁用，因此该检查尤其有帮助。我们描述了一个病例，该简单的床边检查成功加快了正确治疗并改善了患者的护理。
