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目的 探讨肋间神经重复电刺激（IRNS）和膈神经重复电刺激（PRNS）对激素冲击治疗时重症肌无力（MG）患者呼吸受累的预测价值。方法 治疗开始前3天内检测36例MG患者PRNS和IRNS,同时观察用力肺活量（FVC）、MG临床评分、治疗中临床呼吸症状变化。结果 大剂量激素治疗后 2-13天14例（40％）患者出现呼吸功能受累或原有呼吸困难加重,呼吸功能恶化患者与未恶化患者相比,上述参数及MG临床类型均有明显差异。Lo-gistic回归分析显示3Hz及5Hz的IRNS双侧波幅衰减均值超过30％时比不超过时发生呼吸困难或原有呼吸困难加重的相对危险度均为19.523.结论 治疗中呼吸功能受累与上述指标及MG临床分型均有关系,IRNS可以预测是否发生呼吸功能恶化。
Objective To investigate the predictive value of intercostal nerve electrical stimulation (IRNS) and phrenic nerve repetitive electrical stimulation (PRNS) on respiratory involvement in patients with myasthenia gravis during hormone shock therapy. Methods PRNS and IRNS in 36 patients with MG were detected within 3 days before the start of treatment. FVC, clinical scores of MG and changes of clinical respiratory symptoms during the treatment were also observed. Results In 14 patients (40%) 2-14 days after high-dose hormones, respiratory dysfunction or original dyspnea was exacerbated. Compared with those without exacerbation, these parameters and MG clinical types were significantly different. Lo-gistic regression analysis showed that the relative risk of breathing dysfunction or original dyspnea worsened at 3Hz and 5Hz when the average amplitude of both sides of IRNS attenuation exceeded 30% was 19.523 .Conclusion The treatment of respiratory dysfunction and the above indicators And the clinical classification of MG are related, IRNS can predict whether respiratory deterioration occurs.