PLASMAPHERESIS AND GUILLAIN-BARRE-SYNDROME - ANALYSIS OF PROGNOSTIC FACTORS AND THE EFFECT OF PLASMAPHERESIS
PLASMAPHERESIS AND GUILLAIN-BARRE-SYNDROME - ANALYSIS OF PROGNOSTIC FACTORS AND THE EFFECT OF PLASMAPHERESIS
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DOI：
10.1002/ana.410230406
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发表时间：
1988-04-01
影响因子：
11.2
通讯作者：
QUASKEY, SA
中科院分区：
文献类型：
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作者：
MCKHANN, GM;GRIFFIN, JW;QUASKEY, SA
众所周知，格林-巴利综合征的恢复时间差异很大，但与差异相关的因素之前还没有定义。在这项研究中，我们使用多变量分析来确定这些因素，并确定特定因素的存在或不存在是否会影响治疗决定，特别是血浆置换的使用。将245名患者随机分为常规组和血浆置换组，评估患者的独立行走时间(2级)、提高1级的时间，以及4周后改善的百分比。就个体而言，许多因素与结果相关。在多因素分析中，四个因素与较差的预后相关：刺激远端复合肌肉动作电位的平均波幅为正常或更低的20%，年龄较大，起病时间不超过7天，以及需要呼吸机支持。对远端刺激的复合肌肉动作电位的异常平均波幅是最有力的预后预测因子。血浆置换是医生唯一可以影响的变量，除了这些因素之外，它还有一个有益的效果。在连续流动机上进行血浆置换的患者比在间歇式流动机上的患者有更好的结果。根据这些数据，编制了预期结果概率表。
The time course of recovery in the Guillain-Barre syndrome is known to vary widely, but factors associated with differences have not been previously defined. In this study we used multivariate analysis to identify such factors and to determine whether the presence or absence of specific factors would influence treatment decisions, particularly the use of plasmapheresis. Data from 245 patients randomized into conventional and plasmapheresis arms were used to assess the time to walk independently (Grade 2), the time to improve one grade, and the percentage improved at 4 weeks. Individually, many factors were associated with outcome. In the multivariate analysis, four factors correlate with poorer outcomes: mean amplitude of compound muscle action potential on stimulating distally of 20% of normal or less, older age, time from onset of disease of 7 days or less, and need for ventilatory support. The most powerful predictor of outcome was the abnormal mean amplitude of compound muscle action potential on stimulating distally. Plasmapheresis, the only variable the physician can influence, has a beneficial effect over and above any or all of these factors. The plasmapheresis patients on continuous flow machines had better outcomes than those on intermittent flow machines. From these data, tables of expected outcome probabilities have been developed.