重症肌無力危象之血漿分離療法

Plasmapheresis in Myasthenic Crisis

葉建宏(Jiann-Horng Yeh) ； 邱浩彰(Hou-Chang Chiu)

《重症醫學雜誌》 11卷2期 (2010/08) Pp. 80-89

https://doi.org/10.30035/TCCM.201008.0001

摘要

爲了探討血漿分離術對肌無力危象的治療療效及分析影響使用呼吸器時間的預後因素，本研究回顧性整理過去16年間，共有84位重症肌無力(myasthenia gravis, MG)病人、發生123次肌無力危象，且全部皆經過一個雙重濾過血漿分離術(double filtration plasmapheresis, DFP)治療的病歷紀錄。經過一個DFP療程後，全部MG分數進步中數爲4分（-11至12分）、進步超過（含）2分者，被視爲有顯著療效占62%：危象天數中數9天（1至241天），68%病人得以在2週內脫離呼吸器。DFP後的MG分數、抗體濃度、肺活量及最大吸氣壓與危象天數都顯著的相關性。在使用氣管內管插管及傳統呼吸器(Endotracheal intubation with mechanical ventilation, ETMV)病人出現肺炎(p=0.0063)、出現任一併發症(p=0.0304)、及未接受胸腺切除術(p=0.0238)會顯著的延長危象的時間。使用雙階正壓呼吸器(Bilevel Positive Airway Pressure, BiPAP)病入在危象天數及ICU留置天數都比ETMV組有顯著的縮短，在併發症中的肺炎及發燒部分也有顯著的減少。總結，DFP治療可以顯著提升危象時的肌力及改善危象的預後。

關鍵字

血漿分離術 ； 肌無力危象 ； 乙烯膽鹼受體抗體 ； 雙階正壓呼吸器 ； 肺功能測試

並列摘要

To investigate the prognostic factors and outcome of myasthenia gravis (MG) patients in crisis treated with double filtration plasmapheresis (DFP); this study retrospectively reviewed the medical records of 84 MG patients with 123 episodes of crisis treated with DFP. After DFP treatment, the median improvement of MG scores were 4 (-11 to 12 points). The reduction of MG score over two points was considered as a good respond, occurring in 62%. The median duration of crisis were 9 days (1-241 days) and 68% of patients could be weaned from the ventilator within 2 weeks. The post-DFP parameters including MG score, antibody titer, vital capacity and maximal inspiratory pressure correlated well with the duration of crisis. In the group of patients using the endotracheal intubation and conventional mechanical ventilation (ETMV), pneumonia (p=0.0063), any kind of complication (p=0.0304), and not receiving thymectomy (p=0.0238) significantly prolonged the duration of crisis. For the user of bilevel positive airway pressure (BiPAP) ventilator, the duration of crisis and ICU stay were significantly shortened in along with the fewer occurrences of complications of pneumonia and fever as compared to the ETMV group. In conclusion, DFP treatment could ameliorate the profound weakness in crisis and improve the prognosis of crisis.

並列關鍵字

Plasmapheresis ； Myasthenic crisis ； Acetylcholine receptor antibody ； Bilevel positive airway pressure ； Pulmonary function test