myasthenic crisis
Introduction
Introduction to myasthenia gravis crisis Myasthenia gravis refers to sudden increase in muscle weakness, respiratory muscles, swallowing muscles, progressive weakness or paralysis, and life-threatening. Myasthenia dystrophic crisis is caused by disease development and anti-cholinesterase drug deficiency. The clinical manifestations are swallowing, coughing, respiratory distress, difficulty and even stop. The physical examination shows dilated pupils, sweating, bloating, and bowel The characteristics of normal sound and neostigmine after the injection of symptoms are improved. basic knowledge The proportion of illness: 0.043% Susceptible people: no specific population Mode of infection: non-infectious Complications: bloating
Cause
Myasthenia gravis crisis
Infection (45%):
Infection is a key cause of myasthenia gravis crisis. When patients are aware of respiratory infections caused by viruses and bacteria, the airway is narrow, airway resistance is increased, respiratory secretions are increased, and patients with muscle weakness are often unable to cough up airway secretions due to muscle fatigue. At the same time, viral infection can lead to an increase in muscle weakness and a crisis.
Excessive fatigue (25%):
Excessive fatigue can also lead to the development of myasthenia gravis crisis. Experts say that when the patients with myasthenia gravis suffer from excessive fatigue and irritation, on the one hand, the body's defense performance will decrease, and respiratory tract infection will occur. On the other hand, excessive fatigue will increase the weakness of the respiratory muscles and swallowing muscles, and induce crisis.
Drug factors (15%):
The appearance of myasthenia gravis crisis and the amount of hormones also have a certain relationship. In the treatment of myasthenia gravis patients, hormones will be used. The short-term impact treatment with large doses of glucocorticoids will lead to the development of myasthenia gravis crisis. The patient will involve the respiratory muscles. Serum acetylcholine receptor antibodies are elevated because hormones may trigger a cholinergic crisis.
Prevention
Myasthenia gravis crisis prevention
1, light should avoid overwork, cold, infection, trauma and irritation, etc., should not be under the scorching sun for a long time to prevent muscle weakness.
2. When the muscle weakness is in crisis, rest in bed, keep calm and quiet, keep the indoor air clear and fresh, clear the nasal cavity and oral secretions in time, and keep the airway open.
3, muscle weakness in the crisis, immediately intramuscular injection of neostigmine 1 mg, if necessary, can be repeated, the symptoms can be changed to oral.
4. In the cholinergic crisis, all anticholinergic enzyme drugs should be stopped, and 0.5 to 2 mg of atropine should be administered intramuscularly or intravenously, repeated once every 15 to 30 minutes.
5. In the case of ruminal crisis, the anti-cholinesterase drug is stopped, and the function of the acetylcholine receptor function receptor in the motor endplate is restored. After at least 72 hours, the anticholinergic enzyme is started from a small dose.
6. If the nature of the crisis is unknown, the anti-cholinesterase drug may be suspended and the prednisone may be used orally.
7. It is forbidden to use drugs that can affect the nerves - muscle joints, such as anesthetics, sedative painkillers, muscle relaxants, antiarrhythmic drugs and certain antibiotics.
Complication
Myasthenia gravis crisis Complications
Myasthenia dystrophic crisis is caused by disease development and anti-cholinesterase drug deficiency. The clinical manifestations are swallowing, coughing, respiratory distress, difficulty and even stop. The physical examination shows dilated pupils, sweating, bloating, and bowel The characteristics of normal sound and neostigmine after the injection of symptoms are improved.
The cholinergic crisis accounts for 1.0% to 6.0% of the number of dangerous cases. Due to the anti-cholinesterase excess, in addition to the common features of muscle weakness, the patient's pupils shrink, sweating, muscles, and bowel The sound of the sound is hyperthyroidism, and the symptoms of the intramuscular injection of Xinsi are aggravated.
The rumination crisis is caused by infection, poisoning and electrolyte imbalance, and can be temporarily relieved by the application of anti-cholinesterase drugs, followed by a critical state of aggravation.
Symptom
Symptoms of myasthenia gravis crisis common symptoms overwork episodes of myalgia dysarthria fatigue dyspnea muscle atrophy sensory disturbance fatigue scapula with muscle atrophy diplopia
1. Myasthenia gravis:
That is, the new sin is not dangerous, often caused by infection, trauma, reduction, respiratory muscle paralysis, cough, swallowing, and life-threatening.
2. Cholinergic crisis:
That is, the new period of excessive crisis, in addition to the aforementioned muscle weakness crisis, there are symptoms of excessive accumulation of acetylcholine:
1 muscarinic poisoning: nausea, vomiting, diarrhea, abdominal pain, small pupil, sweating, runny, more tracheal secretions, slow heart rate.
2 niacin-like poisoning symptoms: muscle tremor, convulsions, tight feeling.
3 central nervous symptoms: anxiety, insomnia, mental confusion and so on.
3. Anti-crime:
It is difficult to distinguish the nature of the crisis and can not be used to stop the drug or increase the dose of the drug to improve the symptoms, more often after long-term larger dose treatment.
Examine
Examination of myasthenia gravis crisis
1. The laboratory experiments that need to be done for this disease are: 1 neostigmine test, 2 chlorinated Tengxiong test.
2, electrophysiological examination: commonly used inductive power continuous stimulation, damaged muscle response and rapid disappearance.
3, other laboratory tests: serum anti-AChRab determination of about 85% of patients increased, chest X-ray or thymus CT examination, thymic hyperplasia or with thymic tumors, also have diagnostic value.
Diagnosis
Diagnosis and diagnosis of myasthenia gravis crisis
The disease can be diagnosed by understanding the patient's medical history, clinical symptoms, and laboratory findings.
The identification of myasthenia gravis, cholinergic crisis, and rumination crisis, the three types of crisis can be identified by the following methods: 1 Tengxilong test, 2 atropine test, 3 electromyography.
Pay attention to the identification of the weakness of the patient's body caused by other diseases.
