重症吉兰巴雷综合征患者机械通气及出院6个月预后影响因素分析
发布时间：2019-06-27 12:39
【摘要】：目的分析重症吉兰巴雷综合征(GBS)患者机械通气及出院6个月预后的影响因素,为临床治疗提供帮助。方法回顾性分析2009-01-01至2015-12-31首都医科大学宣武医院神经重症监护病房(NCU)收治的50例重症GBS患者的临床资料。分别收集免疫治疗前、出NCU时、出院6个月所有患者的GBS残障量表(H-GBSDS)评分,按照是否进行机械通气、治疗效果是否良好、出院6个月预后是否良好进行分类,并分析性别、年龄、发病前感染性诱因情况、发病至入院时间、颅神经受累情况、自主神经功能障碍情况、肌电图表现为轴索型损害+混合型损害情况对重症GBS患者是否进行机械通气的影响;上述因素以及发病至免疫治疗时间对重症GBS患者治疗效果的影响;上述因素以及机械通气情况、免疫球蛋白(IVIG)治疗1个疗程情况、治疗效果、低蛋白血症情况、低钠血症情况、住NCU时间对重症GBS患者出院6个月预后的影响。结果 50例重症GBS患者中,住院期间死亡2例,随访过程中失访7例,最终完成出院6个月随访41例,其中63.4%(26/41)预后良好。进行机械通气的重症GBS患者自主神经功能障碍率高于未进行机械通气的重症GBS患者(P0.05);治疗效果良好的重症GBS患者发病前有感染性诱因率高于治疗效果不良的重症GBS患者(P0.05);出院6个月预后良好的重症GBS患者治疗效果良好率高于出院6个月预后不良的重症GBS患者,住NCU时间短于出院6个月预后不良的重症GBS患者(P0.05)。多因素Logistic回归分析结果显示,自主神经功能障碍是重症GBS患者是否进行机械通气的独立影响因素[OR=5.573,95%CI(1.027,30.242),P0.05];发病前有感染性诱因是重症GBS患者治疗效果的独立影响因素[OR=4.743,95%CI(1.003,22.442),P0.05];治疗效果、住NCU时间是重症GBS患者出院6个月预后的独立影响因素[OR=59.720,95%CI(4.411,809.698),P0.05;OR=1.069,95%CI(1.007,1.135),P0.05]。结论存在自主神经功能障碍的重症GBS患者需要机械通气概率更大;发病前有感染诱因较无感染诱因的重症GBS患者治疗效果良好;早期治疗效果良好的重症GBS患者出院6个月预后良好,而住NCU时间长的GBS患者出院6个月预后不良;重症GBS患者经过积极治疗,绝大多数预后良好。
[Abstract]:Objective to analyze the influencing factors of mechanical ventilation and 6 months' discharge in patients with severe Guillain Barre syndrome (GBS). Methods the clinical data of 50 patients with severe GBS admitted to (NCU) in Neurointensive Care Unit of Xuanwu Hospital of Capital Medical University from 01 to 2015 to 31 were analyzed retrospectively. the clinical data of 50 patients with severe GBS treated in intensive care unit of Xuanwu Hospital of Capital Medical University were analyzed retrospectively. The GBS disability scale (H-GBSDS) scores of all patients were collected before and after NCU, and classified according to whether mechanical ventilation was performed, whether the treatment effect was good or not, and whether the prognosis was good at 6 months after discharge. Sex, age, infectious inducement before onset, time from onset to admission, craniocerebral nerve involvement and autonomic nerve dysfunction were analyzed. Electromyography showed the effect of axonal damage on mechanical ventilation in patients with severe GBS. The above factors and the effect of onset to immunotherapy time on the therapeutic effect of severe GBS patients, the above factors and mechanical ventilation, immunoglobulin (IVIG) treatment for one course of treatment, therapeutic effect, hyponatremia, NCU stay time on the prognosis of severe GBS patients after 6 months of discharge. Results of the 50 patients with severe GBS, 2 died during hospitalization and 7 lost their follow-up during the follow-up. 41 patients were followed up for 6 months after discharge, of which 63.4% (26 鈮，
本文编号：2506796
[Abstract]:Objective to analyze the influencing factors of mechanical ventilation and 6 months' discharge in patients with severe Guillain Barre syndrome (GBS). Methods the clinical data of 50 patients with severe GBS admitted to (NCU) in Neurointensive Care Unit of Xuanwu Hospital of Capital Medical University from 01 to 2015 to 31 were analyzed retrospectively. the clinical data of 50 patients with severe GBS treated in intensive care unit of Xuanwu Hospital of Capital Medical University were analyzed retrospectively. The GBS disability scale (H-GBSDS) scores of all patients were collected before and after NCU, and classified according to whether mechanical ventilation was performed, whether the treatment effect was good or not, and whether the prognosis was good at 6 months after discharge. Sex, age, infectious inducement before onset, time from onset to admission, craniocerebral nerve involvement and autonomic nerve dysfunction were analyzed. Electromyography showed the effect of axonal damage on mechanical ventilation in patients with severe GBS. The above factors and the effect of onset to immunotherapy time on the therapeutic effect of severe GBS patients, the above factors and mechanical ventilation, immunoglobulin (IVIG) treatment for one course of treatment, therapeutic effect, hyponatremia, NCU stay time on the prognosis of severe GBS patients after 6 months of discharge. Results of the 50 patients with severe GBS, 2 died during hospitalization and 7 lost their follow-up during the follow-up. 41 patients were followed up for 6 months after discharge, of which 63.4% (26 鈮，
本文编号：2506796
本文链接：https://www.wllwen.com/yixuelunwen/shenjingyixue/2506796.html
最近更新
教材专著
