The Analysis Of Predictors Of Dyspnea In Guilian-Barre Syndrome

Objectives:Guillain-Barre syndrome(GBS),also known as acute inflammatory demyelinating polyneuritis(AIDP),is the most common cause of acute paralysis.The prognosis for recovery in patients with GBS can be favorable.However,the mortality rate ranges from 2%to 12%.Respiratory failure is the dangerest risk of this disease.As it is reported,25%-30%GBS patients would appear respiratory failure.The onset of respiratory failure in GBS is insidious and the progress is not gradual but skipping as failure-compensation-decompensation. If we can not identify and manage it early,the most appropriate salvage chance will miss.Because of the acute respiratory failure,anoxic damage and the complications of the whole body will happen. Then the inconvertible bad result will happen.Therefore,it is crucial to identify predictors of dyspnea in Guillain-Barre syndrome.The large-scale and systemic studies both at home and abroad are few,and the predictors they obtained are not identified with each other.On the basis of the conditions in our country,we selected convenient and practical factors and sought to identify clinical predictors of dyspnea in Guillain-Barre syndrome.Methods:We retrospectively review the medical records of 228 patients with GBS admit(?)ed to the department of neurology in the first hospital of Jilin University between March 1st 2003 and February 28th 2009.All the patients are divided into dyspnea group and non-dyspnea group.Compare base line,clinical, auxiliary inspection index sign.Calculate datas include age,dose of protein in the Cerebrospinal fluid,fibrinogen,time to peak disability,disability grade (summation of muscle strength of all legs and arms when the state is lowest). Count datas include sex,season,rheum,diarrhea,sensory sign,sensory syndrome,tendon reflex,abducens paralysis,bifacial paralysis,bulbar paralysis, autonomic dysfunction,pneumonia,high WBC,hypokalium,hypohepatia,EMG indicates demyelinating injury,axonal injury,both demyelinating and axonal injury.Calculate datas use t test and count datas useχ~2 test.After Univariate Analyses and Multivariate Analyses,we identify the predictors of dyspnea.At last,we analyze the relationship between the number of predictors and dyspnea and mechanical ventilation.Result:The result of our study show amid the 228 patients with GBS, dyspnea appeared in 80 patients(35.09%).Univariate Analyses identify the predictors as follws:fibrinogen,time to peak disability,disability grade, diarrhea,sensory syndrome,tendon reflex,bifacial paralysis,bulbar paralysis, autonomic dysfunction,pneumonia,high WBC,hypokalium,hypohepatia,both demyelinating and axonal injury.Though both demyelinating and axonal injury has statistics meaning,wo exclude it because the datas are few.Multivariate analyses identify seven predictors of dyspnea:time to peak disability(P=0.001, OR=0.772),disability grade(P=0.004,OR=0.880),bifacial paralysis(P=0.021, OR=2.871),bulbar paralysis(P=0.004,OR=3.553),autonomic dysfunction (P=0.002,OR=4.361),hypokalium(P=0.011,OR=6.017),the pertinence is that time to peak disability is the lowest and hypokalium is the highest.The further study of the relationship between the number of predictors and dyspnea shows: when the patients have 0 to 3 predictors,the dyspnea rate is 6.67%,13.21%,38.78%and 59.38%,respectively.When the patients have 4 to 5 predictors,both of the dyspnea rate is 100%.There are no patients with all the 6 predictors in our study.The further study of the relationship between the number of predictors and mechanical ventilation shows:None of the patients who have 0 predictors requires mechanical ventilation.When the patients have 1 to 5 predictors,the mechanical ventilation rate is 1.89%,14.29%,31.25%,56.52%and 85.71%, respectively.Conclusions:Time to peak disability,disability grade,bifacial paralysis, bulbar paralysis,autonomic dysfunction,hypokalium are the predictors of dyspnea in GBS patients.Time to peak disability and disability grade are the sheltered factors.And bifacial paralysis,bulbar paralysis,autonomic dysfunction and hypokalium are the dangerous factors.The more the number of predictors,the higher the rate of dyspnea will be,and so is the mechanical ventilation.When the patients have 3 predictors,the dyspnea rate is 59.38%,and the mechanical ventilation rate is 31.25%.So we must pay more attention to these patients,prevent and treat complications,use IVIG in time and stop the illness.When the patients have 4-5 predictors,the dyspnea rate is 100%,and the mechanical ventilation rates are 56.2%and 85.71%,respectively.We must prepare well for the tracheotomy and the mechanical ventilation at any moment. There are no patients with all the 6 predictors in our study.In this study, hypokalium is the only predictor that we can treat at short time.So detecting and inspecting kalium in blood plasma are crucial.