Rantala H, Uhari M, Cherry J D, Shields W D
Department of Pediatrics, University of Oulu, Finland.
Pediatr Neurol. 1995 Nov;13(4):289-92. doi: 10.1016/0887-8994(95)00189-1.
Recently it was found that plasmapheresis and intravenous immunoglobulins are effective in treating patients with Guillain-Barré syndrome (GBS). However, these treatments are expensive and not without possible adverse effects. Because signs and symptoms predictive for respiratory failure in GBS would be helpful in targeting the treatment, risk factors for respiratory failure were evaluated in 120 children with GBS. Twenty children required assisted ventilation. None of the children without any of the following risk factors had respiratory failure. If the symptoms of GBS began within 8 days after a preceding infection, the odds ratio (OR) for respiratory failure was 4.9 [95% confidence intervals (CI): 1.3-18.5]. Cranial nerve involvement was more common in children who required assisted ventilation (15/20 versus 32/100, OR: 6.4, 95% CI: 2.1-19.1). A cerebrospinal protein level > 800 mg/L during the first week had an OR for assisted ventilation of 3.1 (95% CI of OR: 1.04-9.0). In the logistic multivariate model, all of these risk factors were associated with the need for assisted ventilation. On the basis of our findings, preventive treatment with either plasmapheresis or intravenous immunoglobulins could be directed to those children with any of the risk factors; for those patients without the risk factors, clinical monitoring would be satisfactory.
最近发现，血浆置换和静脉注射免疫球蛋白对治疗吉兰-巴雷综合征（GBS）患者有效。然而，这些治疗费用昂贵且并非没有可能的不良反应。由于GBS中预测呼吸衰竭的体征和症状有助于确定治疗目标，因此对120例GBS患儿的呼吸衰竭危险因素进行了评估。20名儿童需要辅助通气。没有任何以下危险因素的儿童均未发生呼吸衰竭。如果GBS症状在前驱感染后8天内出现，呼吸衰竭的比值比（OR）为4.9[95%置信区间（CI）：1.3 - 18.5]。需要辅助通气的儿童中，颅神经受累更为常见（15/20对32/100，OR：6.4，95%CI：2.1 - 19.1）。第一周脑脊液蛋白水平>800mg/L时，辅助通气的OR为3.1（OR的95%CI：1.04 - 9.0）。在逻辑多变量模型中，所有这些危险因素均与需要辅助通气相关。根据我们的研究结果，对于有任何危险因素的儿童，可以采用血浆置换或静脉注射免疫球蛋白进行预防性治疗；对于没有危险因素的患者，临床监测就足够了。
