Guillain-Barre Syndrome在急診的臨床表現

背景：Guillain-Barre syndrome是一種急性侵犯周邊神經的疾病，患者常見的臨床症狀為漸進性的雙側肢體無力、感覺異常、深部肌腱反射消失，並可能合併呼吸衰竭而導致死亡。關於Guillain-Barre syndrome，國內外相關文獻大多僅探討患者在住院期間的治療及預後，較少探討急診評估與診斷的研究。目的：急診收治的Guillain-Barre syndrome患者主訴症狀常不典型，所以正確診斷Guillain-Barre syndrome對急診醫師而言極具挑戰性。本研究擬探討：(1)經急診處置後收住院的Guillain-Barre syndrome患者在急診時的臨床主訴及神經學檢查；(2)急診Guillain-Barre syndrome患者的確診率及預後。方法：採用回溯性研究法，回顧中部某醫學中心自2001年1月至2007年12月期間，主診斷為Guillain-Barre syndrome的住院患者病歷，探討經急診收住院之Guillain-Barre syndrome患者的人口學特性、臨床主訴及症狀、急診初期診斷、住院天數、呼吸衰竭率與死亡率。結果：經急診收住院之Guillain-Barre syndrome患者共有26人，排除未接受完整治療就自動出院3人，以及已被診斷為Guillain-Barre syndrome的轉診患者1人，有效總樣本數為22人，其中男性12人(54.5%)，女性10人(45.5%)，年齡中位數為戲64.5歲（13-86歲），每10萬名急診患者的發生率約為8.5人。在臨床主訴表現方面，出現雙側肢體無力者有7人(31.8%)、單側肢體無力者4人(18.2%)、麻痛感覺者4人(18.2%)。在神經學檢查異常方面，出現深部肌腱反射消失者20人(90.9%)、感覺異常者14人(63.6%)、腦神經病變者10人(45.5%)。急診初期診斷為Guillain-Barre syndrome的患者僅有3人，比例為13.6%。在預後部份，患者住院天數之中位數為15.0天（6-147天），呼吸衰竭發生率為50.0%，死亡4人，死亡率為18.2%。結論：Guillain-Barre syndrome患者在急診的臨床表現常不典型，在急診的正確診斷率只有13.6%，因此急診醫師應增進對於Guillain-Barre syndrome的認知與警覺性。當患者主訴為肢體無力或感覺異常且合併深部肌腱反射消失時，應懷疑患者為Guillain-Barre syndrome的可能性。早期正確診斷可使Guillain-Barre syndrome患者盡快接受血漿置換術(plasma exchange)或靜脈注射免疫球蛋白(intravenous immunoglobulin, IVIG)等處置，以減少不良預後的發生。

關鍵字

Guillain-Barre syndrome ；對稱性肢體無力；深部肌腱反射消失；急診

並列摘要

Background: Guillain-Barre syndrome (GBS) is an acute peripheral neuropathy. The usual clinical symptoms are progressive bilateral weakness of the extremities, paresthesia, deep tendon arefleaxia, respiratory failure and death. Most previous reports on GBS in Taiwan have focused on the treatment and prognosis during hospitalization, and only a minority have discussed its diagnosis and evaluation in the emergency department (ED). Our study aims to explore the clinical presentation of GBS patients in the ED and their diagnosis and outcome. . Method: We retrospectively reviewed all patients with a new diagnosis of GBS between January 2001 and December 2007 at a medical center in central Taiwan. Patient data, chief complaints, initial diagnosis, length of hospitalization, incidence of respiratory failure, and mortality were assessed. Results: Excluding four patients (three patients discharged against advise and one who was diagnosed with GBS before referral), we collected 22 GBS patients. There were twelve males and ten females, and their median of age was 64.5 years (13-85). The incidence of GBS was 8.5 per 100,000 ED visits. Seven patients presented with bilateral weakness (32%), 4 with unilateral weakness (18%) and 4 with numbness or pain (18%). Twenty patients had deep tendon areflexia (91%), 14 had paresthesia (64%), and 10 had cranial nerve involvement (46%). Only 3 patients (14%) were diagnosed with GBS in the ED. The median length of hospitalization was 15 days (6-147 days), the incidence of respiratory failure was 50% and the mortality rate was 18% (4 deaths). Conclusions: The presentation of Guillain-Barre syndrome in the ED is sometimes atypical. The correct diagnosis was made in only 3 of 22 patients in our ED. Emergency physicians must be familiar with its presentation and suspect GBS in patients with weakness or paresthesia and deep tendon areflexia. If the correct diagnosis is made in the ED, patients can receive plasma exchange or intravenous immunoglobulin treatment earlier, and may avoid poor outcomes such as respiratory failure or death.

並列關鍵字

Guillain-Barre syndrome ； bilateral extremity weakness ； deep tendon areflexia ； emergency department

國際替代計量

Guillain-Barre Syndrome在急診的臨床表現

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