神经病学精品教学：Guillain-Barré syndrome.pptVIP

Differential Diagnosis acute myelitis myasthenia gravis periodical paralysis polymyositis SCD (subacute combined degeneration of the spinal cord) Management The treatment of GBS has two components: Supportive care Specific therapy Supportive Care Supportive care remains the cornerstone of therapy Patients with suspected GBS should be hospitalized,regardless of how mild their disorder appears initially ICU admissions occurs in ~ 30% of GBS patients who are hospitalized Supportive Care Patients must be assessed and monitored to avoid the major life-threatening complications of GBS Respiratory failure Venous thromboembolism Dysautonomia Respiratory Failure The most serious complication and most common Assessment of respiratory function Arterial blood gas analysis PaO270mmHg mechanical ventilation Specific Therapy The specific treatment of choice for GBS since 1978 has been plasmapheresis Beneficial in patients of all ages Some studies using intravenous immunoglobulin (IVIg) treatment for GBS have produced encouraging results Plasmapheresis Objective improvement in at least 50% of patients Must be instituted early in the course of the disorder to be effective 40 to 50 ml/kg over 5 to 8 days of treatment The drawbacks Expensive and invasive Rare complications such as hypotension and sepsis Potential blood product exposures IVIg Treatment 0.4 g/kg/dx5 days Advantages over plasmapheresis Simpler to administer Costs slightly less Drawback The transmission of viral infections, including HIV, is a significant concern, because IVIg is made from plasma pooled from many donors Corticosteroids ineffective in the treatment of GBS ！ ？ Drugs: Vitamin B, ATP physiotherapy Prognosis Most patients are hospitalized for at least 1 month ~ 75 % of patients recover without serious neurological sequelae ~ 5 % of patients die  谢谢！ Guillain-Barré syndrome Guillain-Barré syndrome(GBS) Acute inflammatory demyelinating polyneuropathy (AIDP) polyradiculoneuropath