Department of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
Neurological Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
BMC Neurol. 2019 Jul 19;19(1):172. doi: 10.1186/s12883-019-1384-5.
Myasthenic crisis (MC) often requires admission to an intensive care unit (ICU).
We retrospectively investigated 113 consecutive patients with first MC admitted to the neurological ICU. Patients' demographic, clinical and other characteristics were examined, as well as therapeutic interventions, mortality and functional outcome.
MC patients at first onset admitted to neurological ICU had a mortality rate of 18.6%. PCO level before intubation and score on Myasthenia Gravis-Activities of Daily Living (MG-ADL) scale at MC onset correlated with duration of ventilation and length of ICU stay. Compared with patients with good functional outcome, patients with intermediate or poor functional outcome were older at first MC onset, had lower pH and PO, and had higher PCO before intubation. Multivariate logistic analysis identified pre-intubation PCO level as an independent predictor of survival. Cox regression showed that age at first MC onset requiring ICU management was the factor which significantly influenced the mortality.
Our results suggest that PCO before intubation and MG-ADL score at MC onset may be useful indicators of more severe disease likely to require extensive respiratory support and ICU management. Higher pre-intubation PCO indicates chronic respiratory acidosis that can increase risk of severe disability and death, especially in patients with older age at first MC onset.
肌无力危象（MC）常需入住重症监护病房（ICU）。
我们回顾性调查了 113 例首次发生 MC 并入住神经科 ICU 的连续患者。检查了患者的人口统计学、临床和其他特征，以及治疗干预、死亡率和功能结局。
首次发病入住神经科 ICU 的 MC 患者死亡率为 18.6%。插管前 PCO 水平和 MC 发病时重症肌无力日常生活活动（MG-ADL）评分与通气时间和 ICU 住院时间相关。与功能结局良好的患者相比，功能结局中等或较差的患者首次 MC 发病时年龄较大，pH 值和 PO 较低，插管前 PCO 较高。多变量逻辑分析确定插管前 PCO 水平是生存的独立预测因子。Cox 回归显示，首次需要 ICU 管理的 MC 发病时的年龄是显著影响死亡率的因素。
我们的结果表明，插管前 PCO 和 MC 发病时的 MG-ADL 评分可能是疾病更严重的有用指标，可能需要广泛的呼吸支持和 ICU 管理。插管前 PCO 较高表明存在慢性呼吸性酸中毒，会增加严重残疾和死亡的风险，尤其是在首次 MC 发病时年龄较大的患者中。
