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目的分析TPE在GBS抢救治疗中的应用效果。方法对严重四肢瘫痪,呼吸肌麻痹的17名患者均行气管切开,呼吸机辅助呼吸,在内科常规药物治疗的基础上,采用全自动血细胞分离机,择机对患者实施TPE治疗。比较置换前后患者血清抗体、补体变化情况。采用SPSS13.0统计学软件统计分析,并对患者TPE治疗时间与呼吸肌麻痹恢复撤除呼吸机辅助呼吸时间对比预后结果分析。结果置换后血清抗体和补体均值明显低于置换前,具有统计学意义P<0.05,患者2名治愈,8名疗效显著,5名显效,2名无效,治疗总有效率为88.24%。其中在发病<10 d行TPE治疗的12名患者,10名3～30 d呼吸肌麻痹恢复,2名治愈,8名疗效显著,2名显效,治疗总有效率100%。另外5名发病>10 d行TPE治疗,撤除呼吸机辅助呼吸时间均>30 d,3名显效,2名死亡,治疗总有效率60%。结论 TPE是极重型GBS抢救治疗较为有效的方法之一,在诊断明确病情允许的前提下,尽早实施TPE治疗,可有效降低辅助呼吸需求,缩短恢复时间。
Objective To analyze the application of TPE in the treatment of GBS. Methods A total of 17 patients with severe quadriplegia and respiratory muscle paralysis underwent tracheotomy and ventilator assisted breathing. On the basis of conventional medical therapy, TPE was given to patients by using automatic blood cell separator. Before and after comparing patients with serum antibody, complement changes. SPSS13.0 statistical software was used for statistical analysis, and compared the prognosis of patients with TPE treatment time and respiratory muscle paralysis recovery and removal of ventilator-assisted breathing time. Results The mean of serum antibody and complement after the replacement was significantly lower than before replacement, with statistical significance (P <0.05). Two patients were cured, eight were effective, five were effective and two were ineffective. The total effective rate was 88.24%. Among 12 patients who underwent TPE for 10 days or less, 10 patients recovered from 3 to 30 days of respiratory muscle numbness, 2 were cured, 8 were effective, 2 were effective, and the total effective rate was 100%. The other 5 patients who developed TPE for 10 days had> 30 days of ventilator-assisted resuscitation and 3 were effective and 2 died, and the total effective rate was 60%. Conclusions TPE is one of the most effective methods for salvage treatment of very severe GBS. As soon as TPE is diagnosed, TPE treatment can effectively reduce the need for assisted breathing and shorten the recovery time.