Acute infectious polyradiculoneuritis, also known as Guillain-Barré syndrome, has a disease cause that is not yet fully understood. It is generally believed to be a delayed allergic reaction caused by various disease-causing factors such as viral infections, leading to inflammatory demyelinating disease of peripheral nerves and nerve roots. It is characterized by multiple symmetric peripheral paralysis, mild sensory disturbances, and cerebrospinal fluid protein-cell dissociation. In severe cases, respiratory muscle paralysis and cranial nerve damage may occur.

bubble_chart Diagnosis

The disease can occur throughout the year but is more common from July to September. It is more prevalent in northern regions than in southern areas of China and occurs more frequently in rural areas than in urban settings. School-aged children are most commonly affected. (1) Clinical Manifestations A history of preceding infection is often present 1–3 weeks before the onset of illness. The vast majority of cases have an acute onset, with symptoms progressing to their peak within 1–2 weeks. The main manifestations are as follows: 1. **Motor Dysfunction** Symptoms typically begin in the lower limbs and progress upward. Paralysis is mostly symmetrical, more severe distally than proximally, with weakened or absent tendon reflexes and accompanying muscle atrophy in the affected limbs. 2. **Sensory Dysfunction** Generally mild, occurring mainly in the initial stage of the illness, presenting as subjective sensory disturbances such as pain, numbness, or itching. 3. **Cranial Nerve Dysfunction** Often involves multiple cranial nerves simultaneously, though isolated involvement of a single cranial nerve may also occur. 4. **Autonomic Dysfunction** Children frequently exhibit excessive sweating, flushed or cool skin, and sometimes autonomic symptoms such as arrhythmia, tachycardia, unstable blood pressure, or bladder dysfunction. 5. **Respiratory Muscle Paralysis** Respiratory muscle paralysis can be classified into three grades: - **Grade I**: Weakened voice, weak cough, no dyspnea, slightly increased respiratory rate, compensatory enhancement of upper chest movement, paradoxical breathing during crying or deep breathing. Fluoroscopy shows slight weakening of intercostal or diaphragmatic movement. - **Grade II**: Further weakening of voice and cough, presence of dyspnea, significantly increased respiratory rate, marked compensatory enhancement of upper chest movement, paradoxical breathing even while speaking. Fluoroscopy reveals obvious diaphragmatic weakness, with movement amplitude less than half an intercostal space. - **Grade III**: Severe dyspnea, cough reflex nearly absent, respiratory rate more than double the normal rate, paradoxical breathing even at rest. (2) Laboratory Findings Most children exhibit cerebrospinal fluid (CSF) albuminocytologic dissociation, characterized by elevated protein levels with normal cell counts. CSF protein levels typically begin to rise one week after disease onset, peak at 2–3 days, and gradually decline after four weeks.

﹝Treatment﹞

(1) General Treatment and Nursing Care The pathological process of this disease is mostly reversible and self-limiting, and no special treatment is required unless respiratory paralysis occurs. For limb paralysis, frequent turning is necessary to prevent bedsores; attention should be paid to maintaining the functional position of the paralyzed limbs to prevent deformities such as foot drop. During the stage of convalescence, acupuncture, tuina, and physical therapy can be used to promote nerve function recovery and prevent muscle atrophy. (2) Treatment for Respiratory Muscle Paralysis For cases with obvious respiratory muscle paralysis, it is important to keep the respiratory tract unobstructed, correctly determine the indications for tracheotomy, and promptly use a ventilator. 1. Indications for Tracheotomy (1) Grade III respiratory muscle paralysis. (2) Grade II respiratory muscle paralysis accompanied by glossopharyngeal and vagus nerve paralysis, with significantly increased secretions. (3) Grade II or higher respiratory muscle paralysis complicated by pneumonia or atelectasis. (2) Indications for Ventilator Use 1. Respiratory muscle paralysis where respiratory function cannot meet physiological needs, leading to obvious hypoxemia and hypercapnia. 2. After nasal oxygen administration, the arterial oxygen partial pressure remains below 60mmHg, and the carbon dioxide partial pressure exceeds 45mmHg. 3. Significant respiratory irregularity, apnea, accompanied by consciousness and circulatory disturbances. (3) Adrenocortical Hormones There is still controversy regarding corticosteroid treatment. Generally, mild cases in children do not require hormone therapy. For severe cases, hydrocortisone at 5–10mg/kg per day or dexamethasone at 0.2–0.4mg/kg per day can be administered intravenously. After the condition stabilizes, switch to oral administration and gradually reduce the dosage over 3–4 weeks before discontinuation. (4) Antibiotics Prophylactic use of antibiotics is generally not recommended. Antibiotics should be used only in cases of concurrent infections or during corticosteroid therapy.