Toamad Umarudee, Kongkamol Chanon, Setthawatcharawanich Suwanna, Limapichat Kitti, Phabphal Kanitpong, Sathirapanya Pornchai
Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Occupational Health Unit, Department of Community Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Singapore Med J. 2015 Oct;56(10):558-61. doi: 10.11622/smedj.2015152.
Severe Guillain-Barré syndrome (GBS) causes ventilatory insufficiency and the need for prolonged artificial ventilation. Under circumstances where medical care for patients with severe GBS is required in a resource-limited institution, identifying initial clinical presentations in GBS patients that can predict respiratory insufficiency and the need for prolonged mechanical ventilation (> 15 days) may be helpful for advanced care planning.
The medical records of patients diagnosed with GBS in a tertiary care and medical teaching hospital from January 2001 to December 2010 were retrospectively reviewed. The demographic data and clinical presentations of the patients were summarised using descriptive statistics. Clinical predictors of respiratory insufficiency and the need for prolonged mechanical ventilation (> 15 days) were identified using univariate logistic regression analysis.
A total of 55 patients with GBS were included in this study. Mechanical ventilation was needed in 28 (50.9%) patients. Significant clinical predictors for respiratory insufficiency were bulbar muscle weakness (odds ratio [OR] 5.08, 95% confidence interval [CI] 1.31-21.60, p = 0.007) and time to peak limb weakness ≤ 5 days (OR 0.75, 95% CI 0.62-0.91, p < 0.001). Bulbar muscle weakness (p = 0.006) and time to peak limb weakness ≤ 5 days (p < 0.001) were also found to be significantly associated with the need for prolonged mechanical ventilation (> 15 days).
Bulbar weakness and time to peak limb weakness ≤ 5 days were able to predict respiratory insufficiency and the need for prolonged mechanical ventilation in patients with GBS.
严重吉兰 - 巴雷综合征（GBS）会导致通气功能不全，需要长时间进行人工通气。在资源有限的机构中，当需要对严重GBS患者进行医疗护理时，识别GBS患者中可预测呼吸功能不全以及需要长时间机械通气（> 15天）的初始临床表现，可能有助于进行高级护理规划。
回顾性分析了2001年1月至2010年12月在一家三级医疗和医学教学医院被诊断为GBS的患者的病历。使用描述性统计方法总结了患者的人口统计学数据和临床表现。通过单因素逻辑回归分析确定呼吸功能不全以及需要长时间机械通气（> 15天）的临床预测因素。
本研究共纳入55例GBS患者。28例（50.9%）患者需要机械通气。呼吸功能不全的显著临床预测因素为延髓肌无力（优势比[OR] 5.08，95%置信区间[CI] 1.31 - 21.60，p = 0.007）以及肢体无力达到峰值的时间≤ 5天（OR 0.75，95% CI 0.62 - 0.91，p < 0.001）。延髓肌无力（p = 0.006）和肢体无力达到峰值的时间≤ 5天（p < 0.001）也被发现与需要长时间机械通气（> 15天）显著相关。
延髓肌无力和肢体无力达到峰值的时间≤ 5天能够预测GBS患者的呼吸功能不全以及需要长时间机械通气的情况。
