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目的探讨以脑神经受损为首发症状的吉兰-巴雷综合征(GBS)的临床特点及治疗。方法将11例以脑神经受损为首发症状的GBS患儿随机分为治疗组和对照组。2组均予常规治疗,对照组6例加用激素治疗;治疗组5例加用静脉用免疫球蛋白(IVIG)治疗,剂量为0.4 g.kg-1.d-1,连续应用5 d为1个疗程。按照Hughes等的方法进行神经功能缺损评分。结果 2组于治疗5~7 d时面神经麻痹症状好转,其次为脑神经Ⅸ、Ⅹ受损症状好转,而肢体无力、感觉麻木等症状恢复较慢,平均2~3周才明显好转。对照组2例因呼吸困难行气管插管及呼吸机辅助呼吸。2组治疗7 d Hughes评分比较差异无统计学意义(P>0.05);治疗14 d、21 d,2组Hughes评分比较差异均有统计学意义(Pa<0.05)。结论对于不明原因的脑神经受损,特别是累及双侧脑神经Ⅶ、Ⅸ、Ⅹ的患儿,应考虑GBS的可能。IVIG治疗以脑神经受损为首发症状的GBS疗效显著。
Objective To investigate the clinical features and treatment of Guillain-Barre syndrome (GBS) with brain injury as the first symptom. Methods Eleven cases of GBS with cranial nerve injury as the first symptom were randomly divided into treatment group and control group. The rats in the two groups were treated by conventional therapy, 6 cases in the control group were treated with hormone therapy, and 5 cases in the treatment group were treated with intravenous immunoglobulin (IVIG) at the dose of 0.4 g.kg-1.d-1 for 5 days 1 course of treatment. Neurological deficit scores were calculated as described by Hughes et al. Results The symptoms of facial nerve paralysis were improved in group 2, followed by cranial nerve Ⅸ. The symptoms of Ⅹ damage improved. However, the symptoms of limb weakness and numbness recovered slowly, and the symptoms were obviously improved after 2-3 weeks. Two patients in the control group received intubation and ventilator assisted breathing due to dyspnea. There was no significant difference in Hughes score between the two groups on the 7th day (P> 0.05). There was significant difference in the Hughes scores between the two groups on the 14th, 21st, and 21st days (P <0.05). Conclusion For patients with unexplained brain damage, especially in children with bilateral cranial nerves Ⅶ, Ⅸ and Ⅹ, the possibility of GBS should be considered. IVIG treatment of brain damage as the first symptom of GBS significant effect.