Evidence-Based Application of the Plasma Exchange to Improve Muscle Power and Disability Grade in Patients with Guillain-Barré Syndrome

Abstract

<p>格林-巴利症候群是罕見且病程進展快速的急性周邊神經系統病變，未及時治療，將導致四肢癱瘓及呼吸衰竭。本文描述一位71歲男性，接種AstraZeneca（AZ）疫苗後，出現對稱性肢體無力及右側顏面麻痺，經檢查確診為AZ疫苗誘發格林-巴利症候群的急性發炎性脫髓鞘多發性神經病變合併右側貝爾氏麻痺。筆者以神經科專科護理師角度，評估病人與家屬對治療方案之選擇呈現意見分歧，故運用實證方法探討血漿置換術對改善肌肉力量與殘疾程度之成效。 於Cochrane、Embase、MEDLINE、PubMed、 CINAHL及華藝等資料庫，使用“Guillain-Barre Syndrome”、“plasma exchange”、“intravenous immunoglobulin”、“muscle power”及“disability grade”之關鍵字，搜尋2013 年1月至2023 年2月之中英文文獻。經篩選後共計納入3篇研究進行分析，使用OCEBM評讀文獻，結果顯示治療第2週後，接受血漿置換術之介入措施對於殘疾等級和肌肉力量之改善高於靜脈注射免疫球蛋白。本實證應用結果，病人於住院期間確實恢復肌肉力量及改善殘疾程度。希冀藉由此案例分享，做為爾後照護之參考。</p> <p> </p><p>Guillain-Barré syndrome is a rare and rapidly progressing disease characterized by acute peripheral neuropathy. If left untreated, it can lead to quadriplegia and respiratory failure. In this case, a 71-year-old male developed symmetric limb weakness and right facial palsy after receiving the AstraZeneca (AZ) vaccine. The case was diagnosed with acute inflammatory demyelinating polyneuropathy, a form of Guillain-Barré syndrome, along with right Bell’s palsy. The author, a neurological nurse practi-tioner, was trying to resolve the differences in treatment preferences between the patient and his fami-ly members. Therefore, an evidence-based approach was employed to explore the effectiveness of plas-ma exchange in improving muscle strength and disability grade. An electronic literature search was conducted in databases including Cochrane, Embase, MEDLINE, PubMed, CINAHL, and Airiti Li-brary. Keywords such as “Guillain-Barré Syndrome,” “Plasma Exchange,” “Intravenous Immunoglob-ulin,” “Muscle Power,” and “Disability Grade” were applied. Studies in Chinese or English published between January 2013 and February 2023 were screened and three relevant studies were included in the analysis. The Oxford Centre for Evidence-Based Medicine criteria were further applied to review the literature. The results showed that plasma exchange intervention resulted in a greater improvement in disability grade and muscle power compared to intravenous immunoglobulin after the second week of treatment. Empirical evidence indicated that the patient indeed regained muscle strength and im-proved their disability grade during hospitalization. This case is shared as a reference for future care considerations.</p> <p> </p>