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成人吉兰-巴雷综合征患者呼吸肌瘫痪的分析:回顾性分析。

An Analysis of Respiratory Muscle Paralysis of Adult Patients in Guillain-Barré Syndrome: A Retrospective Analysis.

机构信息

Department of Neurology, First Affiliated Hospital of Harbin Medical University, Harbin 150000, China.

Department of Neurology, Heilongjiang Provincial Hospital, Harbin 150000, China.

出版信息

Medicina (Kaunas). 2023 Jul 7;59(7):1267. doi: 10.3390/medicina59071267.

Abstract

Respiratory muscle paralysis is known as a very common complication of Guillain-Barré syndrome (GBS). However, most research has focused on its later stages rather than its earlier stages, including the prognosis of patients with this condition, or factors that act as early predictors of risk. Therefore, our study aimed to identify early predictors of respiratory muscle paralysis in patients with GBS and determine the short-term prognosis of such patients. We recruited 455 GBS patients (age ≥ 18) who had been hospitalized in the First Affiliated Hospital of Harbin Medical University between 2016 and 2021, retrospectively. We recorded clinical and laboratory data and used linear and logistic regression analysis to investigate the relationship between early clinical, examination results, and subsequent respiratory muscle paralysis. Among the 455 patients, 129 were assigned to a respiratory muscle paralysis group and 326 were assigned to a non-respiratory muscle paralysis group. Compared with the non-affected group, the time from onset to admission was shorter ( = 0.0003), and the Medical Research Council (MRC) score at admission and discharge was smaller in the affected group ( < 0.0001). Compared with the non-affected group, the affected group had higher Hughes and Erasmus GBS Respiratory Insufficiency Score (EGRIS) scores at admission and longer hospital stays ( < 0.0001). Patients in the affected group were more likely to have bulbar palsy and lung infections ( < 0.0001). To conclude, bulbar palsy, a higher EGRIS score and Hughes score at admission, a lower MRC score, and a shorter time between onset and admission, are all predictive risk factors for respiratory muscle paralysis in patients with GBS. An increase in any of these factors increases the risk of muscle paralysis. Patients with respiratory muscle paralysis have a poorer short-term prognosis than those without respiratory muscle paralysis. Therefore, we should attempt to identify patients with one or more of these characteristics in the early stages of admission, provide ventilation management, and administer IMV treatment if necessary.

摘要

呼吸肌瘫痪是吉兰-巴雷综合征(GBS)的一种常见并发症。然而,大多数研究都集中在其后期阶段,而不是早期阶段,包括该疾病患者的预后,或作为风险早期预测因素的因素。因此,我们的研究旨在确定 GBS 患者呼吸肌瘫痪的早期预测因素,并确定此类患者的短期预后。我们回顾性地招募了 2016 年至 2021 年期间在哈尔滨医科大学第一附属医院住院的 455 名 GBS 患者(年龄≥18 岁)。我们记录了临床和实验室数据,并使用线性和逻辑回归分析来研究早期临床、检查结果与随后呼吸肌瘫痪之间的关系。在 455 名患者中,129 名患者被分配到呼吸肌瘫痪组,326 名患者被分配到非呼吸肌瘫痪组。与未受影响组相比,受影响组从发病到入院的时间更短( = 0.0003),入院时和出院时的医学研究委员会(MRC)评分更小( < 0.0001)。与未受影响组相比,受影响组入院时和出院时的 Hughes 和 Erasmus GBS 呼吸功能不全评分(EGRIS)更高,住院时间更长( < 0.0001)。受影响组的患者更有可能出现延髓性麻痹和肺部感染( < 0.0001)。总之,延髓性麻痹、入院时较高的 EGRIS 评分和 Hughes 评分、较低的 MRC 评分以及发病与入院之间的时间较短,都是 GBS 患者呼吸肌瘫痪的预测风险因素。这些因素中的任何一个增加都会增加肌肉瘫痪的风险。患有呼吸肌瘫痪的患者的短期预后比没有呼吸肌瘫痪的患者差。因此,我们应该尝试在入院早期识别出具有这些特征之一或更多特征的患者,提供通气管理,并在必要时进行 IMV 治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/511c/10384571/1b5aee6d45ee/medicina-59-01267-g001.jpg

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