Myasthenia Gravis in a Patient with a First Presentation of Acute Hypercapnic Respiratory Failure

以急性高二氧化碳呼吸衰竭為最初表現的重症肌無力症病患：一病例報告

李少武(Shou-Wu Lee) ； 李博仁(Bor-Jen Lee) ； 李宜中(Yi-Chung Lee) ； 侯泰成(Tai-Cheng Hou)

《中華民國急救加護醫學會雜誌》 20卷1期 (2009/03) Pp. 45-50

https://doi.org/10.30018/JECCM.200903.0006

摘要

重症肌無力症的疾病表現特徵為波動性骨骼肌無力，而少有以急性高二氧化碳呼吸衰竭為最初的表現。一位30歲女士因突發性意識障礙來院就診，抽血檢查發現為急性高二氧化碳呼吸衰竭，經過詳細理學檢查、肌電圖檢查以及高anti-AchR抗體值，證實為新診斷的重症肌無力症患者。胸腔電腦斷層同時發現有胸腺瘤。病患經過即時藥物治療、血漿置換以及胸腺瘤割除後，症狀迅速恢復並順利脫離呼吸器。本病例提醒對於不明原因的急性高二氧化碳呼吸衰竭患者，應該將重症肌無力症列入鑑別診斷中，因為診斷與治療的延誤將導致此類病患預後不佳。

關鍵字

急性高二氧化碳呼吸衰竭 ； 重症肌無力症 ； 胸腺瘤

並列摘要

Myasthenia gravis (MG) is a neuromuscular disease characterized by fluctuating weakness in the skeletal muscles, such as the ocular, bulbar, limb and respiratory muscles. Hypercapnic respiratory failure is an uncommon first presentation of MG. A 30 year-old woman was admitted to our hospital due to exacerbated consciousness disturbance, and hypercapnic respiratory failure was found. MG was diagnosed by neurological examination, high anti-AchR antibodies and typical electromyography findings. Chest CT evaluation showed a possible thymoma, and she was treated with oral pyridostigmine, plasmapheresis and surgical thymectomy. The clinical status improved, and she was extubated successfully. We conclude that MG should be considered in the differential diagnosis of unexplained respiratory failure. It is important to recognize this disorder, as it can progress rapidly and has a poor prognosis if not treated promptly.

並列關鍵字

hypercapnic respiratory failure ； myasthenia gravis ； thymoma