Netto Archana Becket, Taly Arun B, Kulkarni Girish B, Uma Maheshwara Rao G S, Rao Shivaji
Department of Neurology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
Department of Neurology, NIMHANS, Bengaluru, Karnataka, India.
J Neurosci Rural Pract. 2017 Jan-Mar;8(1):68-73. doi: 10.4103/0976-3147.193542.
The spectrum of various complications in critically ill Guillain-Barre syndrome (GBS) and its effect on the prognosis is lacking in literature. This study aimed at enumerating the complications in such a cohort and their significance in the prognosis and mortality.
Retrospective case record analysis of all consecutive mechanically ventilated patients of GBS in neurology Intensive Care Unit (ICU) of a tertiary care institute for 10 years was done. Demographic, laboratory, and treatment details and outcome parameters were recorded.
Among the 173 patients were 118 men and 55 women (2.1:1), aged 1-84 years. The average number of ICU complications per patient was 6.8 ± 1.8 (median = 7, range = 1-12). The most common complication was tracheobronchitis (128). Other pulmonary complications were found in 36 patients. The next was metabolic hyponatremia (115) hypokalemia (67), hypocalcemia (13), stress hyperglycemia (10), hyperkalemia (8), hypernatremia (9). Sepsis (40), UTI (47), dysautonomia (27), hypoalbuminemia (76), anemia (75), seizures (8), paralytic ileus (5), bleeding (4), anoxic encephalopathy (3), organ failures (12), deep vein thrombosis (7), and drug rashes (1) were also noted. The complications, considered significant in causing death, Hughes scale ≤ 3 at discharge, prolonged mechanical ventilation (>21 days) and hospitalization (>36 days) were pneumonia, hyponatremia, hypokalemia, urinary infection, tracheobronchial infections, hypoalbuminemia, sepsis, anemia dysautonomia.
Active monitoring and appropriate and early intervention by the clinician will improve the quality of life of these patients and reduce the cost of prolonged mechanical ventilation and ICU stay.
危重症格林-巴利综合征（GBS）各种并发症的范围及其对预后的影响在文献中尚缺乏。本研究旨在列举此类患者群体中的并发症及其在预后和死亡率方面的意义。
对一家三级医疗机构神经重症监护病房（ICU）连续10年接受机械通气的所有GBS患者进行回顾性病例记录分析。记录人口统计学、实验室检查、治疗细节及预后参数。
173例患者中，男性118例，女性55例（2.1:1），年龄1 - 84岁。每位患者ICU并发症的平均数量为6.8±1.8（中位数 = 7，范围 = 1 - 12）。最常见的并发症是气管支气管炎（128例）。36例患者出现其他肺部并发症。其次是代谢性低钠血症（115例）、低钾血症（67例）、低钙血症（13例）、应激性高血糖（10例）、高钾血症（8例）、高钠血症（9例）。还记录到败血症（40例）、尿路感染（47例）、自主神经功能障碍（27例）、低白蛋白血症（76例）、贫血（75例）、癫痫发作（8例）、麻痹性肠梗阻（5例）、出血（4例）、缺氧性脑病（3例）、器官功能衰竭（12例）、深静脉血栓形成（7例）和药物疹（1例）。在导致死亡、出院时休斯量表评分≤3、机械通气时间延长（>21天）和住院时间延长（>36天）方面被认为具有显著意义的并发症是肺炎、低钠血症、低钾血症、尿路感染、气管支气管感染、低白蛋白血症、败血症、贫血、自主神经功能障碍。
临床医生进行积极监测以及适当且早期的干预将改善这些患者的生活质量，并降低机械通气时间延长和ICU住院时间延长的成本。
