Misra Usha K, Kumar Surendra, Singh Varun Kumar, Dubey Deepanshu, Kalita Jayantee
Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Neurol India. 2020 May-Jun;68(3):648-651. doi: 10.4103/0028-3886.289001.
Myasthenic crisis (MC) is mainly managed by invasive ventilation (IV) which is associated with prolonged intubation and ventilation and respiratory complication.
To report the characteristics of patients who can be managed by noninvasive ventilation (NIV) and also predictors of NIV in myasthenia gravis (MG).
In a retrospective study at tertiary care hospital in India during 2013-2015, patients with MG were evaluated. MG was diagnosed by clinical, repetitive nerve stimulation, and acetylcholine receptor antibodies. Patients were intubated based on arterial blood gas criteria. Demographic variables, Myasthenia Gravis Foundation of America (MGFA) score, and clinical examination were done. NIV success was defined if patient did not need mechanical ventilation (MV) in the management or for 72 h after extubation and was considered unsuccessful if patients required MV during this period.
Twenty three out of 68 MG patients had MC, 16 patients were given NIV, and 16 IV. Median intensive care unit stay was 18 (4-94) days. Predictors of crisis were infection, bulbar weakness, MGFA > 2b, and history of crisis. NIV was the only respiratory support in 7 patients and reintubation was prevented in 3 patients. NIV failed in 9 patients. Comparison of NIV success and failure did not reveal any difference.
With NIV, intubation was prevented in 7 and reintubation in 3 patients. NIV has lower incidence of complications. NIV should be tried in patients with impending MC.
重症肌无力危象（MC）主要通过有创通气（IV）进行处理，这与长时间插管、通气及呼吸并发症相关。
报告可通过无创通气（NIV）处理的重症肌无力（MG）患者的特征以及NIV的预测因素。
在印度一家三级医疗中心于2013年至2015年进行的一项回顾性研究中，对MG患者进行了评估。MG通过临床、重复神经电刺激及乙酰胆碱受体抗体进行诊断。根据动脉血气标准对患者进行插管。记录人口统计学变量、美国重症肌无力基金会（MGFA）评分及临床检查结果。若患者在治疗过程中或拔管后72小时内不需要机械通气（MV），则NIV治疗成功；若在此期间患者需要MV，则视为失败。
68例MG患者中有23例发生MC，16例患者接受NIV治疗，16例接受IV治疗。重症监护病房中位住院时间为18（4 - 94）天。危象的预测因素为感染、延髓肌无力、MGFA>2b及危象病史。7例患者仅接受NIV作为呼吸支持，3例患者避免了再次插管。9例患者NIV治疗失败。NIV成功与失败组比较未发现差异。
使用NIV，7例患者避免了插管，3例患者避免了再次插管。NIV并发症发生率较低。对于即将发生MC的患者应尝试使用NIV。
