Shi Jianquan, Huan Xiao, Lv Zhiguo, Zhou Zhirui, Wu Shitao, Zhong Huahua, Yan Chong, Song Jie, Zhou Lei, Xu Yafang, Lin Jie, Zhu Wenhua, Xi Jianying, Luo Sushan, Zhao Chongbo
Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
Department of Neurology, Huashan Hospital Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China.
Neuromuscul Disord. 2022 Mar;32(3):220-229. doi: 10.1016/j.nmd.2021.12.001. Epub 2021 Dec 8.
Weaning from invasive mechanical ventilation (MV) represents a pivotal step for myasthenic crisis (MC) patients. The aim was to evaluate the association between the weaning process and clinical outcomes, as well as to determine the independent predictors for difficult-/prolonged-weaning in MC. MC patients requiring invasive MV were recruited from Jan 2014 through Sep 2020. Among 124 consecutive MC patients, we finally included 66 patients (age 48.4 ± 18.7 years, female 45.5%). According to the WIND (Weaning according to a New Definition) classification, these patients were classified into no-weaning (n = 5, 7.6%), short-weaning (n = 13, 19.7%), difficult-weaning (n = 26, 39.4%), and prolonged-weaning group (n = 22, 33.3%). Four-week functional assessment in short-weaning group was more favorable than that in difficult-/prolonged-weaning group (p<0.001). Length of hospital stay (23.0 (15.0-28.0) vs. 37.5 (27.0-54.8), p<0.001), length of ICU stay (17.0 (8.5-22.5) vs. 34.0 (20.3-45.0), p<0.001), duration on ventilation (6.0 (6.0-8.5) vs. 18.0 (13.3-30.0), p<0.001), and time interval from MV to first weaning (6.0 (6.0-8.0) vs. 11.0 (8.0-20.8), p<0.001) in short-weaning group were significantly shorter than those in difficult-/prolonged-weaning group. Short-weaning group had a lower prevalence of pneumonia (23.1% vs. 75.0%) and systemic inflammatory response syndrome (SIRS) (38.5% vs. 85.4%), and a higher value in the lowest hemoglobin level (123.0 ± 12.9 g/L vs. 108.3 ± 18.1 g/L) and the lowest serum albumin level (33.2 ± 3.4 g/L vs. 29.9 ± 4.2 g/L) than difficult-/prolonged-weaning group. Multivariate logistic regression analysis identified pneumonia and the presence of SIRS within one week of MC as independent predictors for difficult-/prolonged-weaning. The weaning process is associated with clinical outcomes in MC patients requiring ventilation. Pneumonia concurrence and the presence of SIRS within one week of MC were identified as independent predictors for difficult-/prolonged-weaning after invasive MV.
撤掉有创机械通气（MV）对重症肌无力危象（MC）患者而言是关键步骤。目的是评估撤机过程与临床结局之间的关联，并确定MC患者撤机困难/撤机时间延长的独立预测因素。2014年1月至2020年9月招募了需要有创MV的MC患者。在124例连续的MC患者中，最终纳入66例患者（年龄48.4±18.7岁，女性占45.5%）。根据WIND（根据新定义撤机）分类，这些患者被分为未撤机组（n = 5，7.6%）、短时间撤机组（n = 13，19.7%）、撤机困难组（n = 26，39.4%）和撤机时间延长组（n = 22，33.3%）。短时间撤机组的四周功能评估比撤机困难/撤机时间延长组更有利（p<0.001）。短时间撤机组的住院时间（23.0（15.0 - 28.0）天 vs. 37.5（27.0 - 54.8）天，p<0.001）、重症监护病房（ICU）住院时间（17.0（8.5 - 22.5）天 vs. 34.0（20.3 - 45.0）天，p<0.001）、通气持续时间（6.0（6.0 - 8.5）天 vs. 18.0（13.3 - 30.0）天，p<0.001）以及从MV到首次撤机的时间间隔（6.0（6.0 - 8.0）天 vs. 11.0（8.0 - 20.8）天，p<0.001）均显著短于撤机困难/撤机时间延长组。短时间撤机组的肺炎患病率（23.1% vs. 75.0%）和全身炎症反应综合征（SIRS）患病率（38.5% vs. 85.4%）较低，最低血红蛋白水平（123.0±12.9 g/L vs. 108.3±18.1 g/L）和最低血清白蛋白水平（33.2±3.4 g/L vs. 29.9±4.2 g/L）的值高于撤机困难/撤机时间延长组。多因素逻辑回归分析确定肺炎和MC一周内出现SIRS是撤机困难/撤机时间延长的独立预测因素。撤机过程与需要通气的MC患者的临床结局相关。肺炎并发以及MC一周内出现SIRS被确定为有创MV后撤机困难/撤机时间延长的独立预测因素。
