摘要目的探讨抗N-甲基-D-天冬氨酸受体（ NMDAR）脑炎机械通气患者的临床特点及其远期预后。方法对2012年1月至2015年6月连续收入我院的抗NMDAR脑炎首次发病患者进行观察性研究。所有患者均接受肿瘤筛查、对症支持治疗和免疫治疗，并于免疫治疗后每6个月采用改良Rankin评分（ mRS）进行1次预后评估，mRS 0～2分为预后良好。统计学分析机械通气组和非机械通气组患者临床表现、辅助检查和远期预后等指标之间差异有无统计学意义。结果本研究共纳入56例抗 NMDAR脑炎患者，男性28例，年龄12～58（28±12）岁，其中机械通气组患者16例（28.6％）。5例女性患者合并卵巢畸胎瘤（8.9％，5／28），其余患者未发现肿瘤。免疫治疗6个月后，50例（89.3％）患者预后良好，病死率为0。与非机械通气组患者比较，机械通气组患者性别为女性、伴有畸胎瘤、意识障碍、自主神经功能障碍、血浆置换治疗、免疫抑制剂治疗、收住重症监护室的比例更高。机械通气组患者发病至开始机械通气时间为10～73（33±19） d，呼吸机辅助呼吸3～154（46±41） d。不同预后的机械通气患者呼吸机使用天数差异无统计学意义。在6～48个月的随访中，有6例（10.7％）患者复发，其中机械通气组1例（1／16，6.3％），非机械通气组5例（5／40，12.5％），两组间差异无统计学意义。两组间患者远期预后亦差异无统计学意义。结论抗NMDAR脑炎需要机械通气患者通常病情危重、治疗难度大，但经过积极的联合免疫治疗和生命支持，大多数患者可取得较好远期预后。

abstractsObjective To explore the clinical characteristics and long-term outcomes of mechanically ventilated patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis.Methods In this observational study , patients with anti-NMDAR encephalitis were enrolled , who were admitted into Xuanwu Hospital of Capital Medical University from Jan 2012 to Jun 2015.All patients accepted tumor screening , symptomatic therapy , and immunotherapy.Outcomes were assessed by modified Rankin Scale (mRS) after immunotherapy every 6 months, and mRS 0 -2 was defined as favorable outcome.The differences of clinical manifestations , auxiliary examinations , and outcomes between mechanical ventilation (MV) group and no MV group were analyzed.Results Fifty-six patients (mean age 28 ±12 years, range 12 to 58 years) were enrolled, and 28 were male.MV group included 16 (28.6%) patients.Five female patients were diagnosed with ovarian teratoma.After 6 months, 50 patients ( 89.3%) had favorable outcomes, mortality was 0.The proportions of patients being female , with ovarian teratoma, conscious disturbance , dysautonomia , accepting plasmapheresis , immunodepressant treatment , admitted into neuro-critical care unit in MV group were significant higher than those in no MV group.The duration of illness prior to MV was 10-73 days (mean 33 ±19 days).The period of MV was 3-154 days (mean 46 ±41 days).There was no significant difference in the period of using MV among different outcome groups.After 6-48 months′follow-up, 6 patients (10.7%) relapsed, with 1 patient in MV group (1/16, 6.3%), 5 patients in no MV group (5/40, 12.5%).The relapses and long-term outcomes were not significant different between MV group and no MV group.Conclusions The condition of mechanically ventilated patients with Anti-NMDAR encephalitis is severe , and the treatment is difficult.However, after active combined immunotherapy and life support , majority of these patients could get good long-term outcomes.