【摘要】 目的探讨创伤后急性格林-巴利综合征(GBS)的临床特点、诊断与治疗方法及预后情况。方法回顾性分析13例创伤后急性GBS病人的临床资料,包括病史、临床表现、实验室检查、影像学检查以及治疗方法和预后等。结果 13例病人中9例伴有基础疾病,8例因外伤致骨折后发病,5例因手术术后发病,均急性起病。3例发病前有(或可疑)感染病史。13例首发症状均为神经系统症状,其中,以双上肢或双下肢感觉或运动障碍为首发者9例,以脑神经受损为首发症状者4例,合并有呼吸肌麻痹者10例,腹痛者2例,发热者3例,出汗增多者5例,低血压心率减慢者4例,小便障碍者3例,脑膜刺激症者1例,抽搐者1例。脑脊液检查均存在"蛋白细胞分离"现象,肌电图及神经传导速度检查均提示神经源性损害。经治疗以后肌力恢复正常6例,逐渐好转4例,死亡3例。结论创伤后急性GBS多发生于中老年、体质较差的病人,在发病前多有外伤、手术等重大的创伤病史,少数病人可有上呼吸道及消化道感染病史,其临床症状不典型,多以周围神经系统受损为主要症状,同时可累及自主神经系统。早期诊断和后续积极治疗对预后及延缓疾病进展具有重要的作用。更多还原

【Abstract】 Objective To investigate the clinical features,diagnostic and treatment methods,and prognosis of post-traumatic acute Guillain-BarréSyndrome(GBS). Methods A retrospective analysis was performed for the clinical data of 13 patients with post-traumatic acute GBS,including medical history,clinical manifestations,laboratory examination,imaging findings,treatment methods,and prognosis. Results Of all 13 patients,9 had underlying diseases,8 experienced disease onset after fracture caused by trauma,and 5 experienced disease onset after surgery,and acute onset was observed in all patients.Three patients had or were suspected of the medical history of infection before disease onset.All patients had nervous system symptoms as the initial symptoms,among whom 9 had sensory or movement disturbance in both upper or lower limbs,4 had brain nerve injury,10 had respiratory muscle paralysis,2 had abdominal pain,3 had pyrexia,5 had increased sweating,4 had low blood pressure and heart rate,3 had urination disorder,1 had meningeal irritation,and 1 had convulsions.Cerebrospinal fluid examination showed the phenomenon of protein-cell separation in all cases,and electromyography and nerve conduction velocity examination suggested neurogenic damage in all cases.After treatment,muscle strength returned to normal in 6 patients and was gradually improved in 4 patients,while 3 patients died. Conclusion Post-traumatic acute GBS often occurs in middle-aged and elderly patients with a poor constitution.Most patients have a medical history of trauma before disease onset,such as trauma and surgery,and a small number of patients may have a medical history of upper respiratory tract infection and gastrointestinal infection.Such patients tend to have atypical symptoms,with the main symptom of peripheral nervous system injury and the involvement of autonomic nervous system.Early diagnosis and active treatment are vital for prognosis and delay of disease progression.更多还原