肌危机中的断奶和输出失败:一个多中心分析
Bernhard Neumann1,2, Klemens Angstwurm2, Christian Dohmen3,4
1Department of Neurology, Donau-Isar-Klinikum Deggendorf, Deggendorf, Germany.
Journal of neurology
|November 4, 2023
概括
断奶失败 (WF) 和输出失败 (EF) 在需要机械通风的肌危机 (MC) 患者中很常见. 高龄,并发症和并发症增加了WF风险,与IVIG相比,血交换可能会降低WF风险.
科学领域:
- 神经学 神经学
- 临界护理医学 临界护理医学
背景情况:
- 肌痛性危机 (MC) 是肌痛性严重并发症 (MG),通常需要机械通风.
- 了解影响断奶和拔成功的因素对于管理MC患者至关重要.
研究的目的:
- 在MC患者中分析断奶失败 (WF) 和输出失败 (EF) 的频率和风险因素.
- 评估WF和EF对MC临床过程的影响.
- 为了比较不同一线治疗 (IVIG与血交换/免疫吸附) 对WF的疗效.
主要方法:
- 在12个德国神经病学部门 (2006-2015年) 进行了对需要机械通风的MC患者的回顾性图表审查.
- WF的定义是:自发呼吸试验,初级气管切除术或输出失败 (重新输入管/死亡) 的负面结果.
- 统计分析以确定WF和EF的风险因素及其与临床结果的关联.
主要成果:
- 断奶失败 (WF) 在64.2%的发作中发生.
- 风险因素包括老年人,多种并发病 (≥3),晚期发病的MG,,肺炎,CPR和败血症.
- 与血交换或免疫吸收相比,静脉注射免疫球蛋白 (IVIG) 治疗中WF的频率更高.
- 输出失败 (EF) 发生在43.0%的初始尝试中,与长时间的通风和住院相关.
- 在输管后的第7天和第12天之间观察到最佳的输出成功.
结论:
- 在MC中,WF和EF很常见,与不良的临床结果有关.
- 老年,并发症和肺/心脏并发症显著增加了WF和EF的风险.
- 第一线血交换/免疫吸附可能与MC中的第一线IVIG相比较低的WF率有关.
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