外伤、手术相关性吉兰-巴雷综合征的临床观察

目的 观察外伤、手术相关性吉兰-巴雷综合征的临床表现、对静脉注射免疫球蛋白治疗的疗效。方法 回顾性分析16例病前有外伤、手术史的吉兰-巴雷综合征病例，并与同期住院治疗的无外伤或手术的吉兰-巴雷综合征患者的临床表现、治疗效果相比较。结果 外伤、手术继发吉兰-巴雷综合征发生在外伤或手术后3周内，发病前可有咽痛、腹泻史，主要表现为四肢无力，可伴有四肢麻木，严重病例有呼吸困难。主要体征为四肢肌力下降、肌腱反射减弱或消失，可有感觉异常。与同期住院治疗的吉兰-巴雷综合征患者相比，外伤、手术继发吉兰-巴雷综合征患者临床表现较重（P＜0.05）。大部分病例脑脊液化验表现为脑脊液蛋白-细胞分离现象。肌电图检查有髓鞘脱失、轴索变性表现。在接受静脉注射免疫球蛋白治疗后，与无外伤或手术的吉兰-巴雷综合征患者比较，外伤、手术继发吉兰-巴雷综合征患者效果差（P＜0.01）。结论 静脉注射免疫球蛋白治疗外伤、手术继发的吉兰-巴雷综合征效果差。应重视外伤、手术继发吉兰-巴雷综合征，及时诊断、治疗，改善患者预后。

Clinical observation of Guillain Barré syndrome following trauma and operation

Objective To observe the clinical manifestation and the therapeutic efficacy of intravenous immunoglobulin(IVIg) for patients with Guillain Barré syndrome following trauma and operation. Methods A retrospective analysis was conducted on 16 patients with Guillain Barré syndrome following trauma and operation. Then, these patients were compared with non trauma and non operation patients in aspect of clinical features and IVIg therapeutic efficacy. Results The patients complicated with Guillain Barré syndrome within 3 weeks after trauma and operation may have pharyngalgia and diarrhea before Guillain Barré syndrome. The major clinical manifestations were weakness and numbness of limbs and some severe cases had symptom of dyspnea. The physical signs were low muscular tension and deep tendon reflex or disappeared with or without paresthesia. The clinical pictures of the patients were more severe than non traumatic and non operatic cases. In CSF of most patients, dissociation of protein from cell can be found. The electromyography examination showed demyelization and axonal degeneration. After IVIg therapy, the efficacy of patients following trauma and operation was poor as compared with that of non trauma and non operation patients(P＜0.01). Conclusion The efficacy of IVIg in patients following trauma and operation is poor. Doctors should treat secondary Guillain Barré syndrome patients after trauma and operation to improve the prognosis of patients through in time diagnosis and treatment.