患女,60岁,因双手指麻木10d,四肢无力4d加重伴饮水呛咳,吞咽困难2d入院。查体:神志清楚,构音不清。神经系统检查:软腭动度差,咽反射 减弱,伸舌受限,双上肢近端肌力Ⅱ级,右下肢近端肌力Ⅲ级,四肢肌张力低,四肢呈套式感觉障碍,腱反射消失,病理反射未引出。腰穿脑脊液:蛋白583mg/L,细胞数0×10~9/L,血沉40mm/h,血清k~+5.2mmol/L,心肌酶谱正常,头颅CT未见异常,心电图大致正常。诊断:格林-巴利综合征。入院后呼吸困难进行性加重,呼吸肌麻痹,入院第4天心电图示窦性心律,V_(1～3)呈rS型,V_(4～6)呈9RS Affected women, 60 years old, because of two fingers numb 10d, limb weakness 4d aggravated with cough and drinking water, difficulty swallowing 2d admission. Examination: Consciousness, articulation unclear. Nervous system examination: poor palatal mobility, reduced pharyngeal reflex, extension of the tongue restricted, upper extremity proximal muscle strength Ⅱ, right lower extremity muscle strength Ⅲ, limb muscle tension is low, limbs were nested sensory disturbances, tendon reflex Disappeared, pathological reflex did not lead. Lumbar puncture cerebrospinal fluid: protein 583mg / L, the number of cells 0 × 10 ~ 9 / L, erythrocyte sedimentation rate 40mm / h, serum k ~ +5.2mmol / L, myocardial enzymes normal, no abnormal cranial CT, ECG roughly normal. Diagnosis: Guillain-Barre syndrome. Admitted to dyspnea after admission, respiratory muscle paralysis, admission on the fourth day ECG showed sinus rhythm, V_ (1 ~ 3) was rS type, V_ (4 ~ 6) was 9RS