摘要
目的探讨围手术期应用新的重症肌无力(myasthenia gravis,MG)外科临床分型及分期降低术后肌无力危象(myasthenic crisis,MC)发生率的有效性。方法回顾性分析2018年1月—2022年6月河南省人民医院重症肌无力综合诊疗中心收治的全身型MG患者的临床资料。在首次就诊、术前1 d、术后3 d采用重症肌无力日常活动能力(myasthenia gravis-activities of daily living,MG-ADL)评分及重症肌无力定量(quantification of the myasthenia gravis,QMG)评分评估患者状况。按照新的外科临床分型根据疾病发展过程将患者分为A组(Ⅱ型)、B组(Ⅲ型+Ⅳ型+Ⅴ型),所有患者均通过药物等干预将症状控制在缓解期或稳定期后行胸腔镜下胸腺(瘤)扩大切除术,分析术后MC发生率及手术的有效率。采用正态分布法和百分位数法计算QMG评分与MGADL评分单侧95%参考值范围。结果纳入126例患者,其中男62例、女64例,年龄13~71(46.00±13.00)岁。A组95例,B组31例,两组患者术前基线资料差异无统计学意义(P>0.05)。A组患者术后MC发生率1.05%(1/95)、B组3.23%(1/31),两组差异无统计学意义(P>0.05)。术前1 d QMG评分与MG-ADL评分有效分值单侧95%参考值范围为0~7.75和0~5.00。两组患者术后无死亡。结论新的MG外科临床分型及分期可指导手术时机的选择,使MG手术患者从中受益,极大可能降低术后MC发生率。
Objective To exploring the effectiveness of perioperative application of new surgical clinical classification and staging for myasthenia gravis(MG)in reducing the incidence of postoperative myasthenic crisis(MC).Methods The clinical data of patients with generalized MG admitted to the Comprehensive Treatment Center for Myasthenia Gravis of Henan Provincial People’s Hospital from January 2018 to June 2022 were retrospectively analyzed,who were scored with myasthenia gravis-activities of daily living(MG-ADL)score and quantification of the myasthenia gravis(QMG)score at the first visit,1 day before surgery,and 3 days after surgery.The patients were divided into a group A(typeⅡ)and a group B(typeⅢ+Ⅳ+Ⅴ)by the new surgical clinical classification and staging of MG according to the disease progression process,and all patients underwent expanded thoracoscopic thymus(tumor)resection after medication and other interventions to control symptoms in remission or stability.The incidence of MC and the efficiency rate after surgery were analyzed.The normal distribution method and percentile method were used to calculate the unilateral 95%reference range of the QMG score and MG-ADL score.Results Finally 126 patients were enrolled,including 62 males and 64 females,aged 13-71 years,with an average age of 46.00±13.00 years.There were 95 patients in the group A and 31 patients in the group B,and the differences of the preoperative baseline data between the two groups were not statistically significant(P>0.05).The incidence of postoperative MC was 1.05%(1/95)in the group A and 3.23%(1/31)in the group B(P>0.05).The effective one-sided 95%reference range of the QMG score and MG-ADL score 1 day before surgery was 0-7.75 and 0-5.00,and there was no postoperative death in both groups.Conclusion The new surgical clinical classification and staging of MG can guide the timing of surgery,which can benefit patients undergoing surgery for MG and greatly reduce the incidence of postoperative MC.
作者
张永辉
马文强
黄玉炜
张志文
王猛
史宸硕
崔新征
张清勇
ZHANG Yonghui;MA Wenqiang;HUANG Yuwei;ZHANG Zhiwen;WANG Meng;SHI Chenshuo;CUI Xinzheng;ZHANG Qingyong(Comprehensive Treatment Center for Myasthenia Gravis,Zhengzhou University People’s Hospital,Henan Provincial People’s Hospital,Zhengzhou,450003,P.R.China)
出处
《中国胸心血管外科临床杂志》
CSCD
北大核心
2023年第6期853-857,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
河南省科技攻关项目(212102310153)。
关键词
重症肌无力
临床分型
临床分期
评分
肌无力危象
Myasthenia gravis
clinical classification
clinical staging
score
myasthenic crisis
