Yip R C, Heckmatt J Z
Department of Pediatrics, Watford General Hospital, UK.
Neuropediatrics. 1998 Feb;29(1):23-5. doi: 10.1055/s-2007-973528.
Three patients, aged 7-15 years, with Guillain-Barré syndrome presented with pain as the primary complaint. Two did not complain of weakness and their progressive loss of function was incorrectly ascribed to the pain. One did complain of weakness, in association with flu-like symptoms, but the significance of the complaint was not appreciated. At diagnosis all three had profound, predominantly proximal weakness. We believe the delayed diagnosis relates to doctors' lack of opportunity to examine patients with muscle weakness. We conducted a questionnaire survey of junior hospital doctors asking them about their hands-on experience of testing muscle strength and about their knowledge of the Medical Research Council (MRC) Scale of muscle strength. Doctors who claimed most experience did not have a better knowledge of the MRC scale. We recommend doctors-in-training should be given more opportunity to examine patients with muscle weakness and should be made familiar with a clinical scale of muscle strength.
三名年龄在7至15岁的吉兰-巴雷综合征患者以疼痛作为主要诉求就诊。其中两名患者并未诉说肌无力症状，其功能的逐渐丧失被错误地归因于疼痛。另一名患者确实诉说了肌无力症状，同时伴有流感样症状，但该症状的重要性未得到重视。在诊断时，这三名患者均有严重的、主要为近端肌无力症状。我们认为诊断延迟与医生缺乏检查肌无力患者的机会有关。我们对初级医院医生进行了问卷调查，询问他们测试肌肉力量的实践经验以及对医学研究委员会（MRC）肌肉力量分级的了解情况。声称经验最丰富的医生对MRC分级的了解程度并不更高。我们建议应为实习医生提供更多检查肌无力患者的机会，并使他们熟悉肌肉力量的临床分级。
