Risk factors of myasthenic crisis after thymectomy in 178 generalized myasthenia gravis patients in a five-year follow-up study
Risk factors of myasthenic crisis after thymectomy in 178 generalized myasthenia gravis patients in a five-year follow-up study
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DOI：
10.3109/00207454.2014.883391
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发表时间：
2014-11-01
影响因子：
2.2
通讯作者：
Bu, Bitao
中科院分区：
文献类型：
--
作者：
Yu, Shanshan;Lin, Jing;Bu, Bitao
目的：本研究旨在评估术后肌无力危象（PMC）患者的临床特征，并确定影响PMC发生的危险因素。方法：对178例平均发病年龄36.8岁的重症肌无力患者行胸腺扩大切除术。采用二分类Logistic回归分析潜在危险因素。结果：在5年以上的随访中，44例（24.7%）患者发生了58次PMC。手术和PMC首次发作之间的平均间隔为13.8个月，81.8%的患者发生在胸腺切除术后的前2年内。9/16例（56.3%）术前有MC病史的患者有复发性危象。呼吸道感染是PMC最常见的促发因素。单因素分析显示，发病年龄、术前MGFA分级、术前MC、是否有延髓症状、手术时间、术中出血量和是否有胸腺瘤与PMC的发生显著相关。然而，多因素Logistic回归分析显示，术前MC病史（OR = 2.845，p = 0.044）、存在延髓症状（OR = 3.062，p = 0.027）和手术持续时间较长（OR = 1.026，p = 0.009）是PMC的独立危险因素。结论：全身型MG患者发生PMC的重要危险因素包括存在延髓症状、术前MC病史和手术时间较长。加强术前评估和围手术期护理可降低PMC的发生率。
Purpose: The aims of this study were to assess the clinical characteristics of patients with postoperative myasthenic crisis (PMC) and to identify the risk factors affecting the occurrence of PMC. Method: Extended thymectomy was performed on 178 patients with generalized MG with a mean onset age of 36.8 years. The potentially risk factors were analyzed by binary logistic regression analysis. Result: During the over five-year follow-up, 44 patients (24.7%) experienced 58 episodes of PMC. The mean interval between surgery and the first episodes of PMC was 13.8 months, and for 81.8% of the patients it occurred within the first 2 years after thymectomy. Nine of 16 patients (56.3%) with a history of preoperative MC had recurrent crises. Respiratory tract infection was the most common precipitant of PMC. Univariate analysis showed that age at onset, preoperative MGFA class, preoperative MC, presence of bulbar symptoms, operation duration, amount of intraoperative blood loss, and the presence of thymoma were significantly associated with the occurrence of PMC. However, multivariate logistic regression analysis revealed that a history of preoperative MC (OR = 2.845, p = 0.044), presence of bulbar symptoms (OR = 3.062, p = 0.027), and longer operation duration (OR = 1.026, p = 0.009) were the independent risk factors for PMC. Conclusion: The important risk factors for developing PMC in generalized MG patients include the presence of bulbar symptoms, history of preoperative MC, and longer operation duration. Optimization of the preoperative evaluation and proper perioperative care of MG patients may decrease the frequency of PMC.