Plasma exchange for Guillain‐Barré syndrome

摘要: Background Guillain-Barre syndrome is an acute symmetric, usually ascending and paralysing illness, due to inflammation of peripheral nerves. It thought be caused by autoimmune factors, such as antibodies. Plasma exchange removes antibodies other potentially injurious factors from the blood stream. involves connecting patient's circulation a machine which exchanges plasma for substitute solution, albumin. Several studies have evaluated syndrome. Objectives To systematically review evidence concerning efficacy treating Search strategy Cochrane Neuromuscular Disease Trial Register randomised trials in syndrome, search bibliographies identified papers enquiry authors papers. Selection criteria Randomised quasi-randomised versus sham or supportive treatment. Data collection analysis Potentially relevant were scrutinised two reviewers selection eligible was agreed them third reviewer. extracted one reviewer checked second Some missing data obtained studies. Main results Six 649 patients identified, all comparing treatment alone. Primary outcome measures ~bullet~Time recover walking with aid In only this measure reported, median time ability faster than control group. onset motor recovery mildly affected trial available, significantly shortened Secondary ~bullet~Improvement disability grade at four weeks five trials, there more who had improved group compared Patients treated fared better following secondary measures: without aid, percentage requiring artificial ventilation, duration full muscle strength after year, severe sequelae year. There less infectious events cardiac arrhythmias Subgroup analyses beneficial mild, moderate (needing ventilation) disease seven days also those lasting days. However, that enrolled up 30 onset, benefit apparent. Type Single showed superior none mild but six not ventilation. One study suggested continuous flow intermittent flow. Another found no significant difference between techniques. The same higher rate adverse fresh frozen replacement fluid cerebrospinal filtration A single these treatments did show any outcomes too small demonstrate equivalence. Reviewer's conclusions first has been proven alone Consequently, should regarded against new treatments, intravenous immunoglobulin, judged. sessions are none. two. four. Continuous machines may albumin fluid. when started within rather later, still onset. value children 12 years old known. insufficient determine whether equivalent exchange.