摘要目的 探讨重症肌无力危象前状态的临床特征以及发展为肌无力危象的相关因素.方法 收集2007年10月至2016年7月在中山大学附属第一医院重症肌无力专科住院期间进入危象前状态的重症肌无力患者共93例,其中25例患者进入危象前状态2次及以上,共计127例次.用自制调查表回顾处于危象前状态患者一般情况、临床表现、血气分析结果.用描述性分析、单因素Logistic相关分析、多因素Logistic相关分析等方法进行统计学分析.结果 (1)重症肌无力危象前状态最显著的临床特征为:呼吸困难(127例次,100%未气管插管和使用侵入性或非侵入性呼吸支持),球部肌肉无力(121例次,95.28%),血二氧化碳分压升高(94例次,85.45%),咳痰无力(99例次,77.95%),睡眠障碍(107例次,84.25%),感染(99例次,77.95%).其中呼吸困难合并球部肌肉无力(P=0.002)、血二氧化碳分压升高(P=0.042)往往提示即将发生危象.(2)重症肌无力危象前状态发展至危象的相关因素包括球部肌肉无力(P=0.028)、发热(P=0.028)、营养不良(P=0.066)、并发症(P=0.071)、口咽分泌增多(P=0.005)、血二氧化碳分压升高(P=0.007),而胸腺手术在围手术期后并不会增加危象发生的风险.结论 发生呼吸困难提示MG患者进入危象前状态,及早在危象前状态积极处理呼吸困难、球部肌肉无力、血二氧化碳分压升高、咳痰无力、睡眠障碍、感染与发热、防止口咽分泌增多所导致的窒息有助于减少危象的发生.

abstractsObjective To investigate the clinical features of the Pre-Crisis State and analyze the correlated risk factors of Pre-Crisis State of myasthenia crisis .Methods We included 93 patients with myasthenia gravis (MG) who experienced 127 times Pre-Crisis State between October 2007 and July 2016. Those patients were hospitalized in the MG specialize center , Department of Neurological Science , first Affiliated Hospital of Sun Yat-sen University . The information of the general situation , the clinical manifestations and the blood gas analysis in those patients were collected using our innovated clinical research form.Statistic methods were applied including descriptive analysis , univariate logistic analysis , multivariate correlation logistic analysis , etc.Results ( 1 ) The typical features of MG Pre-Crisis State included:dyspnea (127 times, 100% not requiring intubation or non-invasive ventilation), bulbar-muscle weakness (121 times, 95.28%), the increased blood partial pressure of carbon dioxide (PCO2) (94 times, 85.45%), expectoration weakness (99 times, 77.95%), sleep disorders (107 times, 84.25%) and the infection (99 times, 77.95%).The occurrence of dyspnea in combination with bulbar-muscle weakness (P=0.002) or the increased blood PCO2(P=0.042) often indicated the tendency of crisis .(2) The MG symptoms which were proportion to the occurrence of crisis includes:bulbar-muscle weakness ( P=0.028), fever (P=0.028), malnutrition (P=0.066), complications (P=0.071), excess oropharyngeal secretions (P=0.005) and the increased blood PCO2(P=0.007).The perioperative period of thymectomywould not increase the risk of crisis .Conclusions Dyspnea indicates the occurrence of the Pre-Crisis State of MG.In order to significantly reduce the morbidity of myasthenia crisis , the bulbar-muscle weakness , the increased blood PCO 2 , expectoration weakness , sleep disorders , infection&fever and excess oropharyngeal secretions should be treated timely .