以呼吸衰竭为主诊的重症肌无力3例误诊分析

刘鸿翔¹ 张一凡¹
Songjiang Hospital Affiliated to First Peoples Hospital of Shanghai Jiaotong University

Objective: To improve the awareness and early diagnosis level of Myasthenia Gravis (MG) and myasthenic crisis. Methods: Review and analysis of three cases of MG patients with the respiratory failure as the main performance. Three patients were rescued from the emergency room or Respiratory Medicine Division and received intensive care in ICU. According to the reason of acute respiratory failure among three patients, 1 case was misdiagnosed as viral encephalitis; 1 case was misdiagnosed as acute exacerbation of chronic obstructive pulmonary disease; 1 case was misdiagnosed as sudden death. Results: Three patients returned their consciousnesses rapidly with the treatment of mechanical ventilation, but it was difficult for them to remove the ventilator. After checking their serum acetylcholine receptor antibodies with the positive expressions, they successfully removed the ventilator by administrating of pyridostigmine bromide in the end. Conclusions: It is easy to make a misdiagnosis when some chronic diseases accompany with MG or myasthenic crisis. It is necessary for us to consider and confirm the diagnosis of MG when there are no reasonable explanations for difficulty of removing ventilator in patients with type 2 Respiratory failure.