以手术为诱因的重型吉兰巴雷综合征临床特点和预后分析

发布时间：2018-11-01 15:32

【摘要】：目的初步探讨以手术为前驱因素的重型吉兰巴雷综合症(Guillain-Barre syndrome,GBS)的临床特点和预后。方法从62例重型GBS患者中收集6例以手术为前驱因素GBS患者的临床资料,对患者的手术、起病时间、达峰时间、临床症状、电生理检查和治疗方案等进行总结,并随访至1年,结合休斯功能分级量表(Hughes functional grading scale,HFGS),评价患者的临床特点及其预后。结果根据临床及电生理表现,6例以手术为前驱因素的重型GBS患者均诊断为急性运动轴索性神经病。手术诱因包括体外循环手术、颈动脉内膜剥脱术、基底动脉瘤栓塞术、颅内血肿钻孔引流术、椎间盘置换术、椎管减压和椎弓根固定术,发病年龄在47~63岁之间,潜伏期多在10 d之内,达峰时间均在5 d之内,4例肢体无力起病,2例呼吸困难起病;发病3个月,6例患者均不能独立行走(HFGS=4),5例随访至1年,仅2例能独立行走(HFGS=2)。结论以手术为前驱因素的重型GBS少见,常以肢体无力或呼吸困难起病,达峰时间快,预后差。
[Abstract]:Objective to investigate the clinical features and prognosis of severe Guillain-Barre syndrome (Guillain-Barre syndrome,GBS) with surgical prophylaxis. Methods the clinical data of 6 patients with severe GBS were collected from 62 patients with severe GBS. The operation, onset time, peak time, clinical symptoms, electrophysiological examination and treatment plan were summarized and followed up to 1 year. The clinical features and prognosis of the patients were evaluated with the Hughes functional rating scale (Hughes functional grading scale,HFGS). Results according to the clinical and electrophysiological manifestations, all the 6 patients with severe GBS were diagnosed as acute motor axonal neuropathy. Surgical causes include cardiopulmonary bypass, carotid endarterectomy, embolization of basilar aneurysms, drilling and drainage of intracranial hematoma, intervertebral disc replacement, decompression of the vertebral canal and pedicle fixation. The incubation period was more than 10 days, and the peak time was within 5 days. 4 cases had limb weakness and 2 cases had dyspnea. After 3 months, 6 patients could not walk independently (HFGS=4), 5 patients were followed up to 1 year, only 2 patients could walk independently (HFGS=2). Conclusion severe GBS with surgery as the leading factor is rare. It often starts with limb weakness or dyspnea. The peak time is fast and the prognosis is poor.
【作者单位】：中国康复研究中心北京博爱医院神经内科;
【分类号】：R745.43

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