肋间神经重复电刺激在激素冲击治疗重症肌无力中的应用

目的探讨肋间神经重复电刺激(IRNS)和膈神经重复电刺激(PRNS)对激素冲击治疗时重症肌无力(MG)患者呼吸受累的预测价值.方法治疗开始前3天内检测36例MG患者PRNS和IRNS,同时观察用力肺活量(FVC)、MG临床评分、治疗中临床呼吸症状变化.结果大剂量激素治疗后2～13天14例(40%)患者出现呼吸功能受累或原有呼吸困难加重,呼吸功能恶化患者与未恶化患者相比,上述参数及MG临床类型均有明显差异.Lo-gistic回归分析显示3Hz及5Hz的IRNS双侧波幅衰减均值超过30%时比不超过时发生呼吸困难或原有呼吸困难加重的相对危险度均为19.523.结论治疗中呼吸功能受累与上述指标及MG临床分型均有关系,IRNS可以预测是否发生呼吸功能恶化.

The application of intercostal repetitive nerve stimulation during the treatment of myasthenia gravis with large dosage of adrenal corticosteroid.

Objective To detect the predictive value of intercostal repetitive nerve stimulation (IRNS) and phrenic repetitive nerve stimulation (PRNS) on the respiratory dysfunction of myasthenia gravis (MG) patients during the treatment with large dosage of adrenal cortieosteroid. Methods PRNS and IRNS of 36 MG patients were tested 3 days before the beginning of the treatment. Forced vital capacity (FVC), clinical score and respirator)' changes of the MG patients were simultaneously observed. Results 14 patients showed respiratory dysfunction or worsened respiratory dysfunction 2 to 13 days after the beginning of the therapy . There were significant differences of the above parameters between the patients with and without respiratory deterioration during the treatment. Logistic regression analysis showed that when the mean value of the bilateral IRNS amplitude decrement was larger than 30% , the odds ratio of the occurrence of the respiratory deterioration was 19.523, for both 3 and 5 Hz stimulation. Conclusions The respiratory damage during the treatment is associated with PRNS, IRNS, FVC, MG clinical score and classification. IRNS has a predictive value on the respiratory deterioration during the treatment.