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择期脊柱手术后吉兰-巴雷综合征超急性起病:一例报告及文献复习

Superacute onset of Guillain-Barré syndrome after elective spinal surgery: A case report and literature review.

作者信息

Zhang Xinyu, Yu Deshui

机构信息

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.

出版信息

Medicine (Baltimore). 2024 May 3;103(18):e37925. doi: 10.1097/MD.0000000000037925.

DOI:10.1097/MD.0000000000037925
PMID:38701319
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11062723/
Abstract

RATIONALE

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.

PATIENT CONCERNS

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.

DIAGNOSES

Post elimination of variables linked to anesthetic agents, encephalon, and spinal cord pathologies, a potent suspicion of superacute GBS onset emerged.

INTERVENTIONS

Subsequent to immunoglobulin therapy, plasmapheresis, and adjunctive support, the patient's ultimate demise became manifest.

OUTCOMES

No progress was found to date.

LESSONS

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.

摘要

理论依据

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。

患者情况

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。

诊断

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。

干预措施

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。

结果

迄今为止没有进展。

经验教训

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。

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本文引用的文献

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Guillain-Barré Syndrome with Respiratory Failure following Spine Surgery for Incomplete Cervical Cord Injury: A Case Report and Literature Review.不完全性颈髓损伤后路手术后并发呼吸衰竭的格林-巴利综合征:病例报告及文献复习。
Medicina (Kaunas). 2022 Aug 6;58(8):1063. doi: 10.3390/medicina58081063.
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An International Perspective on Preceding Infections in Guillain-Barré Syndrome: The IGOS-1000 Cohort.国际视角下吉兰-巴雷综合征的前驱感染:IGOS-1000 队列研究。
Neurology. 2022 Sep 20;99(12):e1299-e1313. doi: 10.1212/WNL.0000000000200885. Epub 2022 Aug 18.
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Early Onset of Guillain-Barré Syndrome Following Lumbar Disc Herniation Surgery: An Unexpected Clinical Evolution.
World Neurosurg. 2021 May;149:296-297. doi: 10.1016/j.wneu.2021.02.140.
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Antecedent infections in Guillain-Barré syndrome: a single-center, prospective study.格林-巴利综合征的前驱感染:一项单中心前瞻性研究。
Ann Clin Transl Neurol. 2019 Dec;6(12):2510-2517. doi: 10.1002/acn3.50946. Epub 2019 Nov 12.
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Current treatment practice of Guillain-Barré syndrome.吉兰-巴雷综合征的现行治疗方法。
Neurology. 2019 Jul 2;93(1):e59-e76. doi: 10.1212/WNL.0000000000007719. Epub 2019 Jun 7.
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Systematic review of factors associated with the development of Guillain-Barré syndrome 2007-2017: what has changed?2007-2017 年与吉兰-巴雷综合征发展相关因素的系统评价:有何变化?
Trop Med Int Health. 2019 Feb;24(2):132-142. doi: 10.1111/tmi.13181. Epub 2018 Dec 18.
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Regional variation of Guillain-Barré syndrome.格林-巴利综合征的地域差异。
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