重症肌无力病人撤机困难的影响因素及护理对策

重症肌无力是乙酰胆碱受体介导的细胞免疫依赖及补体参与的一种神经-肌肉接头处传递障碍的自身免疫性疾病.     

Sympathetic skin response in patients with myasthenia gravis★ A comparative analysis

BACKGROUND: The examination of sympathetic skin response is an important index for assessing the autonomic nerve function, and patients with myasthenia gravis are always accompanied by dysautonomia. Therefore, it will be important to know whether sympathetic skin response can be used as the index for the clinical evaluation of myasthenia gravis. OBJECTIVE: To investigate the diagnostic value of sympathetic skin response in the damage of autonomic nerve function of patients with myasthenia gravis. DESIGN: A case-controlled comparative observation. SETTING: Department of Neurology and Room of Nerve Electromyogram, the Affiliated Hospital of North Sichuan Medical College. PARTICIPANTS: Thirty outpatients or inpatients with myasthenia gravis were selected from the Department of Neurology, the Affiliated Hospital of North Sichuan Medical College from May 2006 to May 2007, including 9 males and 21 females, aged 8–72 years with a mean age of (28±5) years old. They were all accorded with the diagnostic standards of myasthenia gravis, accompanied by different severity of autonomic nerve symptoms, including poor skin nutrition, sweating of hands and feet, pyknocardia, persistent hypotension, abdominal pain, constipation, etc. They all had not taken any drug affecting the autonomic nerve function before the examination. Informed consents were obtained from all the patients. Meanwhile, 30 healthy physical examinees were enrolled as the normal control group, including 10 males and 20 females, aged 10–75 years with a mean age of (31±5) years old. Approval was obtained from the hospital ethic committee. METHODS: After admission, the patients were examined with sympathetic skin response using DANTEC keypoint 2.0 electromyography evoked potential apparatus (Danmark). The changes of the latency and wave amplitude of sympathetic skin response were observed. The subjects in the normal control group were examined with the same methods at physical examination. Abnormality was judged by the disappearance of wave form, latency longer than that in the normal control group by Mean±2.5SD, or wave amplitude lower than the average value in the normal control group by 50%. MAIN OUTCOME MEASURES: The results of the latency and wave amplitude of sympathetic skin response were compared between the patients with myasthenia gravis and normal controls. RESULTS: All the 30 patients with myasthenia gravis and 30 healthy physical examinees were involved in the final analysis of results. There were no significant differences between the left and right upper and lower limbs in both the myasthenia gravis group and normal control group (P > 0.05). In the myasthenia gravis group, the abnormal rate of sympathetic skin response was 37% (11/30), the latency was prolonged and the wave amplitude was decreased as compared with those in the normal control group, and there were significant differences (P < 0.01). CONCLUSION: Sympathetic skin response can be used as an electrophysiological index for judging the damages of autonomic nerve function in patients with myasthenia gravis.     

老年重症肌无力30例临床分析

重症肌无力是乙酰胆碱受体介导的神经肌肉接头处传递障碍的自身免疫性疾病，临床特征为部分或全身骨骼肌易于疲劳，常在活动后加重，休息后减轻具有晨轻暮晕等特点。近来一些研究认为，老年人群重症肌无力的发病率较预期要高，临床症状与年轻人也有着明显的不同。上述因素加上老年人常见的疾病谱，给老年人重症肌无力的诊断造成了很大的困难。而且随着社会年龄结构的改变，老龄化人口的比例不断增加，有必要对老年发病的重症肌无力予以重视。     

有机磷中毒中问综合征护理体会

有机磷中毒中间综合征(IMS)是急性中毒1～4d左右，胆碱脂危象基本消失且意识清晰，出现肌无力为主的临床表现。呼吸肌麻痹是其主要危险，急救治疗的关键是迅速而有效地消除呼吸功能障碍，早期发现IMS并做好抢救护理，防止呼吸衰竭是降低有机磷中毒死亡的重要措施。     

医学论文撰写的基本要求

患者，男性，50岁。主诉四肢肌无力进行性加重伴咳嗽、咳痰，消瘦半年。于1987年8月以四肢弛缓：性瘫待查收住我院神经内科。经胸部CT，纤支镜检疑为肺癌，癌性肌无力，但未获病理证实，于1987年9月出院观察。出院后患者自惑四肢肌无力日趋加重，生活不能自理，不能翻身，咳嗽、咳痰情况同前．长期服用抗生素无效。     

雷公藤多甙影响蟾蜍神经—肌接头传递初探

用微电极细胞内记录终板电位（ＥＰＰ）的电生理学方法，在２０只成年蟾蜍的坐骨神经缝匠肌标本上研究了雷公藤多甙（ＴＷＰ）以神经肌接头（ＮＭＪ）兴奋传递的影响。结果表明：ＴＷＰ可引起ＥＰＰ振幅改变，物兴奋传递，而且其影响具有明显的量效依赖关系，适当浓度的ＴＷＰ能明显地增加ＥＰＰ振幅，促进ＮＭＪ的兴奋传递。