Zhang Xinyu, Yu Deshui
Department of Anesthesiology, The Second People's Hospital of Yibin, Yibin, China.
Clinical Research and Translational Center, Second People's Hospital of Yibin City-West China Yibin Hospital, Sichuan University, Yibin, China.
Medicine (Baltimore). 2024 May 3;103(18):e37925. doi: 10.1097/MD.0000000000037925.
Guillain-Barré syndrome (GBS) epitomizes an acute peripheral neuropathy hallmarked by an autoimmune retort directed at the myelin sheath enwrapping peripheral nerves. While it is widely acknowledged that a majority of GBS patients boast a history of antecedent infections, the documentation of postoperative GBS occurrences is progressively mounting. Drawing upon an exhaustive compendium of recent case reports, the disease's inception spans a gamut from within 1 hour to 1.2 years.
At this juncture, we proffer a singular case: an instance involving a 51-year-old gentleman who underwent lumbar spine surgery, only to encounter immediate debilitation of limb and respiratory musculature.
Post elimination of variables linked to anesthetic agents, encephalon, and spinal cord pathologies, a potent suspicion of superacute GBS onset emerged.
Subsequent to immunoglobulin therapy, plasmapheresis, and adjunctive support, the patient's ultimate demise became manifest.
No progress was found to date.
Given GBS's potential to instigate paralysis, respiratory collapse, and autonomic nervous system aberrations, alongside other pernicious sequelae, coupled with the exceptional rarity of the temporal onset in this particular instance, it undeniably proffers an imposing conundrum for anesthetists in the realm of differential diagnosis and therapeutic conduct. During the postoperative convalescence phase under anesthesia, should the patient evince deviant limb musculature vigor and compromised respiratory sinews, the prospect of GBS must not be consigned to oblivion. Precision in diagnosis conjoined with apt therapeutic measures could well be the harbinger of a divergent denouement for the afflicted patient.
吉兰-巴雷综合征(GBS)是急性周围神经病的典型代表,其特征是针对包裹周围神经的髓鞘的自身免疫反应。虽然人们普遍认为大多数GBS患者有前驱感染史,但术后发生GBS的记录也在逐渐增加。根据最近详尽的病例报告汇编,该疾病的发病时间跨度从1小时到1.2年不等。
在此,我们提供一个独特的病例:一名51岁的男性接受了腰椎手术,术后立即出现肢体和呼吸肌肉功能衰弱。
在排除与麻醉剂、脑和脊髓病变相关的变量后,强烈怀疑为超急性GBS发作。
在进行免疫球蛋白治疗、血浆置换和辅助支持后,患者最终死亡。
迄今为止没有进展。
鉴于GBS有可能引发瘫痪、呼吸衰竭和自主神经系统异常以及其他有害后遗症,再加上此例中发病时间极为罕见,这无疑给麻醉师在鉴别诊断和治疗方面带来了一个棘手的难题。在麻醉后的术后恢复期,如果患者出现肢体肌肉力量异常和呼吸肌无力,绝不能忽视GBS的可能性。准确的诊断加上恰当的治疗措施很可能为患病患者带来不同的结局。