Ou C Y, Ran H, Qiu L, Huang Z D, Lin Z Z, Deng J, Liu W B
MG Specialize Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
Zhonghua Yi Xue Za Zhi. 2017 Oct 10;97(37):2884-2889. doi: 10.3760/cma.j.issn.0376-2491.2017.37.002.
To investigate the clinical features of the Pre-Crisis State and analyze the correlated risk factors of Pre-Crisis State of myasthenia crisis. We included 93 patients with myasthenia gravis (MG) who experienced 127 times Pre-Crisis State between October 2007 and July 2016. Those patients were hospitalized in the MG specialize center, Department of Neurological Science, first Affiliated Hospital of Sun Yat-sen University. The information of the general situation, the clinical manifestations and the blood gas analysis in those patients were collected using our innovated clinical research form. Statistic methods were applied including descriptive analysis, univariate logistic analysis, multivariate correlation logistic analysis, etc. (1)The typical features of MG Pre-Crisis State included: dyspnea (127 times, 100% not requiring intubation or non-invasive ventilation), bulbar-muscle weakness (121 times, 95.28%), the increased blood partial pressure of carbon dioxide (PCO(2)) (94 times, 85.45%), expectoration weakness (99 times, 77.95%), sleep disorders (107 times, 84.25%) and the infection (99 times, 77.95%). The occurrence of dyspnea in combination with bulbar-muscle weakness (=0.002) or the increased blood PCO(2) (=0.042) often indicated the tendency of crisis. (2) The MG symptoms which were proportion to the occurrence of crisis includes: bulbar-muscle weakness (=0.028), fever (=0.028), malnutrition (=0.066), complications (=0.071), excess oropharyngeal secretions (=0.005) and the increased blood PCO(2) (=0.007). The perioperative period of thymectomy would not increase the risk of crisis. Dyspnea indicates the occurrence of the Pre-Crisis State of MG. In order to significantly reduce the morbidity of myasthenia crisis, the bulbar-muscle weakness, the increased blood PCO(2), expectoration weakness, sleep disorders, infection & fever and excess oropharyngeal secretions should be treated timely.
探讨重症肌无力危象前状态的临床特征，分析重症肌无力危象前状态的相关危险因素。我们纳入了93例重症肌无力（MG）患者，这些患者在2007年10月至2016年7月期间共经历了127次危象前状态。这些患者均在中山大学附属第一医院神经科学系重症肌无力专科中心住院治疗。我们使用自行设计的临床研究表格收集了这些患者的一般情况、临床表现及血气分析等信息。应用了统计学方法，包括描述性分析、单因素逻辑分析、多因素相关性逻辑分析等。（1）重症肌无力危象前状态的典型特征包括：呼吸困难（127次，100%无需插管或无创通气）、延髓肌无力（121次，95.28%）、血二氧化碳分压（PCO₂）升高（94次，85.45%）、咳痰无力（99次，77.95%）、睡眠障碍（107次，84.25%）及感染（99次，77.95%）。呼吸困难合并延髓肌无力（P = 0.002）或血PCO₂升高（P = 0.042）常提示有危象倾向。（2）与危象发生相关的重症肌无力症状包括：延髓肌无力（P = 0.028）、发热（P = 0.028）、营养不良（P = 0.066）、并发症（P = 0.071）、口咽分泌物过多（P = 0.005）及血PCO₂升高（P = 0.007）。胸腺切除围手术期不会增加危象风险。呼吸困难提示重症肌无力危象前状态的发生。为显著降低重症肌无力危象的发病率，应及时治疗延髓肌无力、血PCO₂升高、咳痰无力、睡眠障碍、感染及发热和口咽分泌物过多等情况。
