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优化吉兰-巴雷综合征男性患者的肺部及功能能力

Refining the Pulmonary and Functional Competencies in a Male Patient With Guillain-Barré Syndrome.

作者信息

Bhagwatkar Sawari S, Harjpal Pallavi

机构信息

Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND.

Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND.

出版信息

Cureus. 2023 Sep 12;15(9):e45101. doi: 10.7759/cureus.45101. eCollection 2023 Sep.

Abstract

Guillain-Barré syndrome (GBS) is the most prevalent form of autoimmune-related acute demyelinating polyneuropathy that affects people of any age group. Its global prevalence is 1.9 per 100,000 people. Acute or subacute symmetrical motor and sensory neuropathy involving several peripheral nerves is referred to as GBS. It typically occurs after an infection caused by a virus, but infrequently with surgery or vaccination. There are different variants of GBS, like acute sensory axonal neuropathy, acute motor axonal neuropathy, and Miller-Fisher syndrome. Motor paralysis that affects distal muscles more than proximal muscles and is more pronounced and symmetrical may be a presenting symptom of GBS. Over the course of several days, it starts in the legs and progresses to the arms, face, and eyes. Reflexes may be missing, bifacial weakness may be present, severe cases result in respiratory paralysis, and autonomic abnormalities may be rare. Patients with GBS exhibit anti-ganglioside antibodies that seem to react with antigens found in some previous infectious pathogens' lipopolysaccharides. These antibodies target gangliosides, like GM1, which are dispersed within the myelin of the peripheral nervous system. There are three phases: acute, plateau, and recovery. Only plasmapheresis and intravenous immunoglobulin have shown effective recovery. A 24-year-old male presented with weakness of the bilateral lower limb associated with fever and breathlessness. The range of motion of hip flexion was reduced to 45 degrees, and muscle power was also reduced. For hip flexors, it was 3/5; for knee flexors and extensors, it was 4/5; and for ankle plantar flexors and dorsiflexors, it was 2/5. Investigations like a complete blood count (CBC), cerebrospinal fluid (CSF) examination, and nerve conduction velocity (NCV) were done. Post-diagnosis, the patient received an intravenous immunoglobulin (IVIG) dose; the same was managed by neurophysiotherapy, and after treatment, the patient was functionally independent. According to the findings of our study, neurorehabilitation resulted in favorable outcomes, shortened the length of the hospital stay, and enabled him to return to his desk job.

摘要

吉兰-巴雷综合征(GBS)是自身免疫相关急性脱髓鞘性多发性神经病最常见的形式,可影响任何年龄组的人群。其全球患病率为每10万人中1.9例。累及多条周围神经的急性或亚急性对称性运动和感觉神经病被称为GBS。它通常发生在病毒感染后,但很少与手术或疫苗接种有关。GBS有不同的变体,如急性感觉轴索性神经病、急性运动轴索性神经病和米勒-费希尔综合征。影响远端肌肉多于近端肌肉且更明显和对称的运动麻痹可能是GBS的首发症状。在几天内,它始于腿部,并进展至手臂、面部和眼睛。反射可能消失,可能存在双侧面肌无力,严重病例会导致呼吸麻痹,自主神经异常可能少见。GBS患者表现出抗神经节苷脂抗体,这些抗体似乎与先前某些感染性病原体脂多糖中发现的抗原发生反应。这些抗体靶向神经节苷脂,如GM1,其分散在外周神经系统的髓鞘内。有三个阶段:急性期、平台期和恢复期。只有血浆置换和静脉注射免疫球蛋白显示出有效的恢复效果。一名24岁男性出现双侧下肢无力并伴有发热和呼吸急促。髋关节屈曲活动范围降至45度,肌肉力量也减弱。髋关节屈肌肌力为3/5;膝关节屈肌和伸肌肌力为4/5;踝关节跖屈肌和背屈肌肌力为2/5。进行了全血细胞计数(CBC)检查、脑脊液(CSF)检查和神经传导速度(NCV)检查等。诊断后,患者接受了静脉注射免疫球蛋白(IVIG)治疗;同时进行了神经物理治疗,治疗后患者功能独立。根据我们的研究结果,神经康复取得了良好的效果,缩短了住院时间,并使他能够重返办公室工作。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6a61/10569148/6e0f3ea34e5e/cureus-0015-00000045101-i01.jpg

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