CAJ | 학술논문

目的：探讨重症肌无力危象的治疗及影响撤机困难的危险因素。方法回顾性分析中山大学附属第一医院院自1994年1月~2011年12月18年间38例重症肌无力危象患者的临床资料，总结其治疗并从性别、年龄、自身免疫性疾病、缺血性心脏病、病程、危象诱因、胸腺瘤、肺部感染、肺不张、激素冲击、菌血症等方面分析影响撤机困难的危险因素。结果38例患者共发生53次危象。5例死亡，危象抢救成功率为90.6%。单因素统计分析表明年龄，P =0.024、感染性诱因，P =0.007、合并肺不张，P =0.011、肺部感染，P =0.027或菌血症，P =0.046组中差异有统计学意义，多因素分析显示年龄，P =0.035、合并肺部感染， P =0.025)与肺不张，P =0.042三种因素差异有统计学意义。结论及时开放气道并予以有效的机械通气辅助呼吸是重症肌无力危象抢救成功的关键；血浆置换或免疫球蛋白治疗，可显著改善危象预后；高龄、合并肺部感染或肺不张与机械通气后撤机困难相关。
목적：탐토중증기무력위상적치료급영향철궤곤난적위험인소。방법회고성분석중산대학부속제일의원원자1994년1월~2011년12월18년간38례중증기무력위상환자적림상자료，총결기치료병종성별、년령、자신면역성질병、결혈성심장병、병정、위상유인、흉선류、폐부감염、폐불장、격소충격、균혈증등방면분석영향철궤곤난적위험인소。결과38례환자공발생53차위상。5례사망，위상창구성공솔위90.6%。단인소통계분석표명년령，P =0.024、감염성유인，P =0.007、합병폐불장，P =0.011、폐부감염，P =0.027혹균혈증，P =0.046조중차이유통계학의의，다인소분석현시년령，P =0.035、합병폐부감염， P =0.025)여폐불장，P =0.042삼충인소차이유통계학의의。결론급시개방기도병여이유효적궤계통기보조호흡시중증기무력위상창구성공적관건；혈장치환혹면역구단백치료，가현저개선위상예후；고령、합병폐부감염혹폐불장여궤계통기후철궤곤난상관。
Objective To evaluate the treatment for myasthenic crisis (MC) and to analyze the risk factors for prolonged mechanical ventilation. Methods A retrospective analysis was performed on 38 MC cases admitted in the hospital between January 1994 and December 2011. Risk factors for prolonged mechanical ventilation were analyzed from age, gender, autoimmune disease, ischemic heart disease, disease duration, precipitating factor, thymoma, pneumonia, atelectasis, high-dose corticosteroid therapy and bacteremia. Results There were 53 occurrences of episodes and 5 cases of death. The survival rate was 90.6%. In the unilabiate analysis, age P =0.024, infectious causes P =0.007, concurrent atelectasis P =0.011, pneumonia P =0.027 and bacteremia P =0.046 were significantly related to prolonged mechanical ventilation, while age P =0.035, concurrent atelectasis P =0.042 and pneumonia P =0.025 were significantly linked with prolonged mechanical ventilation in the multivariate analysis. Conclusion Timely opening the airway and applying appropriate mechanical ventilation are considered being the key for emergency treatment for MC; plasma exchanges or intravenous immunoglobulin can markedly improve the outcome of MC; elder, concurrent atelectasis and pneumonia are the risk factors for prolonged mechanical ventilation.