The Clinical Characteristics And Prognostic Analysis Of Guillain–Barre’ Syndrome With Mechanical Ventilation

Background and Objective The Guillain–Barre’ syndrome(GBS)patients with mechanical ventilation always had a variety of life-threatening complications,which will led to die,if not timely prevention.However,researches at home and abroad were short and inconsistent.Therefore,it was significant to analyze the clinical features and risk factors for poor prognosis of GBS patients with mechanical ventilation.Methods GBS patients with mechanical ventilation were continuously collected from January 1,2008 to October 31,2016 in Xijing Hospital,Tangdu Hospital,The first affiliated Hospital of Xi’an jiaotong university,The second affiliated Hospital of Xi’an jiaotong university Hospital,Shaanxi provincial People’s Hospital,and Xi’an central Hospital.The data included clinic,never electrophysiology,laboratory,and treatment.We analyzed the relevant influential factors for electrophysiology classification and death at discharge.And following up these patients.According to the HFGS,the patients with HFGS >3 were defined as poor prognosis,those with score≤3 as good prognosis.Univariate analysis screened possible factors,and the independent risk factors for poor prognosis was analyzed by logistic regression analysis.Results A total of 109 GBS patients with mechanical ventilation were collected.10 cases died(9.17%)and 11 cases lost to follow-up(10.09%).Male patients were 72 cases(66.05%).The mean age was 48.6 ± 18.1 years.1)Comparing with AIDP subtype,the MRC score was lower(24.49±19.32 vs 38.25±21.17,p=0.019),the HFGS was higher(4.04±1.29 vs 2.88±1.74,p=0.023),and the time of mechanical ventilated was longer(28.08±40.74 vs 11.31±7.35,P=0.008)in AMAN subtype.2)The risk factors for death at discharge included the MRC score at nadir(p=0.017),the time of mechanical ventilation(p<0.05),the time in hospital(p<0.05),and the time in ICU(p<0.05).3)In the univariate analysis,the risk factors for poor prognosis included age(p=0.033),urinary tract infection(p=0.008),the MRC score at nadir(p<0.05),the MRC score at discharge(p<0.05),and the HFGS at discharge(p<0.05),however,facial nerve paralysis(p=0.038)and bulbar paralysis(p=0.001)were factors for good prognosis.4)The independent risk factors for poor prognosis were the MRC score at discharge(p=0.049,OR=0.950,95%CI(0.903,1))and the HFGS at discharge(p=0.021,OR=3.044,95%CI(1.185,7.818)),however,bulbar paralysis(p=0.03,OR=0.227,95%CI(0.059,0.868))was the independent factor for good prognosis.Conclusions For GBS patient with mechanical ventilation in Shaanxi and surrounding province: 1)AMAN subtype was heavier than AIDP;2)The risk factors for death at discharge included: the MRC score at nadir,the time of mechanical ventilation,the time in hospital and the time in ICU;3)The major independent risk factors for poor prognosis was the high HFGS at discharge,but bulbar paralysis was the factor for good prognosis.However,our research was small sample,retrospective and without detailed electrophysiological analysis.Therefore,a prospective,large sample,multicenter study about the prognosis of GBS patients with mechanical ventilation was urgently needed to further verify,and pay attention to the electrophysiological analysis.