Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India.
Neurol India. 2011 Sep-Oct;59(5):707-11. doi: 10.4103/0028-3886.86545.
Severe Guillain-Barré syndrome (GBS) is associated with significant morbidity and also mortality. Identification of modifiable risk factors may help in reducing the morbidity and mortality.
To study the prognostic factors in a selected cohort of mechanically ventilated GBS patients.
Case records of GBS patients requiring mechanical ventilation admitted between 1997 and 2007 were analyzed. All patients satisfied the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) criteria for GBS. Primary outcome parameters included mortality and GBS disability (Hughes) scale score at discharge.
During the study period, 173 (118 men and 55 women; mean age of 33.5 ± 21 years) GBS patients were mechanically ventilated. A history of antecedent events was present in 83 (48%) patients. In addition to motor weakness, In all facial palsy was present in 106 (61%), bulbar palsy in 91 (53%), sensory involvement in 74 (43%), and symptomatic autonomic dysfunction in 27 (16%). The overall mortality was 10.4%. On univariate analysis the risk factors for mortality included elderly age (P = 0.014), autonomic dysfunction (P = 0.002), pulmonary complications (P = 0.011), hypokalemia (P = 0.011), and bleeding (P = 0.026). All these factors were significant in multivariate analysis except for bleeding from any site and hypokalemia. In univariate analysis factors associated with Hughes scale score ≤ 3 at discharge included younger age (P = 0.02), presence of bulbar symptoms (P = 0.03) and less severe weakness at admission (P = 0.02), slower evolution of disease over more than 3 days (P = 0.01), electrodiagnostic evidence of demyelinating neuropathy (P = 0.00), and absence of sepsis (P = 0.01), hyperkalemia (P = 0.0001), and anemia (P = 0.02). In multivariate analysis age was the only significant factor.
Early identification of modifiable risk factors, such as pulmonary involvement, autonomic dysfunction, hypokalemia, sepsis, bleeding, and nutritional complications, may reduce the mortality and morbidity associated with GBS.
严重吉兰-巴雷综合征（GBS）与显著的发病率和死亡率相关。确定可改变的危险因素可能有助于降低发病率和死亡率。
研究机械通气的 GBS 患者队列中的预后因素。
分析了 1997 年至 2007 年间接受机械通气的 GBS 患者的病历记录。所有患者均符合国家神经病学与中风研究所（NINCDS）GBS 标准。主要结局参数包括死亡率和出院时的 GBS 残疾（休斯）量表评分。
在研究期间，173 名（118 名男性和 55 名女性；平均年龄 33.5±21 岁）GBS 患者接受了机械通气。83 名（48%）患者有前驱事件史。除了运动无力外，106 名（61%）患者存在面瘫，91 名（53%）患者存在球麻痹，74 名（43%）患者存在感觉受累，27 名（16%）患者存在症状性自主神经功能障碍。总死亡率为 10.4%。单因素分析显示，死亡的危险因素包括年龄较大（P=0.014）、自主神经功能障碍（P=0.002）、肺部并发症（P=0.011）、低钾血症（P=0.011）和出血（P=0.026）。除了任何部位的出血和低钾血症外，这些因素在多因素分析中均具有统计学意义。单因素分析显示，出院时休斯量表评分≤3 的相关因素包括年龄较小（P=0.02）、存在球症状（P=0.03）和入院时病情较轻（P=0.02）、疾病超过 3 天以上的演变较慢（P=0.01）、电诊断证据为脱髓鞘神经病（P=0.00）和无脓毒症（P=0.01）、高钾血症（P=0.0001）和贫血（P=0.02）。多因素分析中，年龄是唯一有意义的因素。
早期识别可改变的危险因素，如肺部受累、自主神经功能障碍、低钾血症、脓毒症、出血和营养并发症，可能会降低与 GBS 相关的死亡率和发病率。
