强肌健力方在胸腺扩大切除治疗重症肌无力围术期中临床疗效及特点观察

发布时间：2018-01-31 20:52

本文关键词： 重症肌无力强肌健力方围术期重症肌无力危象 PLR NLR　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨在强肌健力方的干预下,对我院收治的重症肌无力患者观察其围术期疗效及临床特点,分析是否能改善和调节重症肌无力患者在围手术期的炎症和免疫水平、术后危象发生率、西药治疗重症肌无力不良反应指标等方面。方法:回顾性分析在我院收治符合标准的99例行胸腺扩大切除术MG患者相关临床资料,通过术前有无服用强肌健力方分为实验组及对照组,对所收集到临床资料进行统计学分析,分析比较两组主要疗效观察指标:包括围手术期(术前,术后第3天)血液分析中各指标、血糖值指标变化规律以及术后MG危象发生情况,次要疗效观察指标:包括术后住院天数、术后气管插管、胃管留置时间等。采用SPSS20.0进行统计学分析。结果:99例病人中,实验组52例,对照组47例。本研究中术后出现重症肌无力危象共8例,其中实验组3例,对照组5例,两组的危象发生率分别为5.76%和10.63%,8例危象患者均顺利出院,可以看出实验组危象发生情况要低于国内外同期平均水平,对照组与国内外平均水平基本持平,可能受样本量的影响,两组术后危象发生情况比较无明显统计学差异,故其有效性需前瞻性大样本数据进一步考证。两组患者在术后NLR、PLR的变化比较以及术后差值的比较中,均有明显的统计学差异(P0.05),说明强肌健力方能明显干预NLR和PLR指标的变化;两组患者在术后血糖、白细胞、血小板药物安全性指标未能得出较为一致的统计学差异,但在白细胞和血小板的差值比较中两组患者是有明显的统计学差异(P0.05),说明强肌健力方的干预能在一定程度上改善单纯西药治疗重症肌无力的药效不良反应,但其有效性亦需进一步的前瞻性大样本数据考证;两组患者在术后住院天数、气管插管和胃管留置时间、术后首次排便时间比较无明显统计学差异(P0.05),故强肌健力方在改善以上各康复指标的作用与否还需进一步实验研究考证。结论:强肌健力方的干预可改善术后MG危象的发生情况,并能一定程度上改善和调节重症肌无力患者的围手术期免疫状态水平、机体的应激及炎症反应。但因本研究为回顾性分析,其有效性需前瞻性大样本随机对照实验进一步证实。在强肌健力方的干预下,与淋巴细胞水平、NLR和PLR水平变化相关性值得进一步探索研究。强肌健力方联合西药治疗MG其术后血糖、白细胞、血小板的药物安全性评价中是否要明显好于单纯西药治疗,亦需前瞻性的大样本研究数据证实。
[Abstract]:Objective: to investigate the perioperative efficacy and clinical characteristics of patients with myasthenia gravis treated in our hospital under the intervention of Qiangjijianli recipe. To analyze whether it can improve and regulate the inflammation and immunity of patients with myasthenia gravis during the perioperative period, and the incidence of postoperative crisis. Methods: the clinical data of 99 patients with MG treated with extended thymectomy in our hospital were retrospectively analyzed. Through the preoperative use of Qiangjijianli prescription divided into experimental group and control group, collected clinical data were statistically analyzed, analysis and comparison of the two groups of main therapeutic indicators: including perioperative period (preoperative). On the third day after operation, the indexes of blood analysis, the change rule of blood glucose index, the occurrence of MG crisis after operation, the secondary curative effect observation index: including postoperative hospitalization days, postoperative tracheal intubation. Results there were 52 cases in the experimental group and 47 cases in the control group. In this study, there were 8 cases of myasthenia gravis crisis after operation. There were 3 cases in the experimental group and 5 cases in the control group. The incidence of crisis in the two groups was 5.76% and 10.63 respectively. It can be seen that the incidence of crisis in the experimental group is lower than the average level at home and abroad in the same period, and the average level of the control group is basically the same as that at home and abroad. There was no significant difference in the incidence of postoperative crisis between the two groups, so the effectiveness of the two groups need to be further verified by prospective large sample data. The two groups of patients in postoperative NLR. There was significant statistical difference in the change of PLR and the difference of postoperative value (P 0.05), which indicated that Qiangjijianli prescription could significantly interfere with the changes of NLR and PLR. Two groups of patients in postoperative blood sugar, white blood cell, platelet drug safety indicators can not reach a more consistent statistical difference. However, there was a significant statistical difference between the two groups in the difference between white blood cells and platelets (P 0.05). The results showed that the intervention of Qiangjijianli recipe could improve the side effects of western medicine in treating myasthenia gravis to a certain extent, but its effectiveness also needed to be verified by further prospective and large sample data. There was no significant difference between the two groups in the days of hospitalization, the time of tracheal intubation and gastric tube indwelling, and the first defecation time after operation (P 0.05). Therefore, the effect of Qiangjijianli recipe in improving the above rehabilitation indexes needs further experimental research. Conclusion: the intervention of Qiangjijianli prescription can improve the occurrence of MG crisis after operation. And to some extent can improve and regulate the patients with myasthenia gravis perioperative immune state, body stress and inflammatory response. But this study is a retrospective analysis. Its effectiveness needs to be further confirmed by a prospective, large sample randomized controlled trial. Under the intervention of Qiangjianli recipe, the level of lymphocytes was increased. The correlation between NLR and PLR levels is worth further study. Qiangjianli prescription combined with western medicine in the treatment of MG postoperative blood glucose, white blood cells. Whether the drug safety evaluation of platelets is significantly better than that of western medicine alone needs to be confirmed by prospective large sample data.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R746.1;R655

【参考文献】