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Colegio de Medicina Interna de México.

2016, Número 3

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Med Int Mex 2016; 32 (3)


Crisis miasténica

Fernández JA, Fernández-Valiñas A, Aldrete-Velasco J, Hernández-Salcedo D, Orozco-Paredes J, Lugo-Dimas A

Idioma: Español
Referencias bibliográficas: 60
Paginas: 341-354
Archivo PDF: 514.99 Kb.


RESUMEN

La miastenia grave es una enfermedad autoinmunitaria que afecta la función motora. Una crisis miasténica pone en peligro la vida. Esta condición se caracteriza por debilidad severa de los músculos respiratorios y bulbares, por lo que los pacientes requieren soporte respiratorio mecánico. La crisis puede desencadenarse por factores ambientales, infecciosos o por medicamentos. El diagnóstico depende de la evaluación adecuada de la función respiratoria. Los aspectos más importantes en el tratamiento son el soporte ventilatorio, donde la ventilación mecánica no invasiva ha tomado gran relevancia, la inmunoterapia con plasmaféresis o inmunoglobulina y las medidas generales en la unidad de cuidados críticos. Otras opciones, como la timectomía, deberán evaluarse en pacientes resistentes. Algunas complicaciones que pueden sobrevenir en estos pacientes son las infecciones pulmonares, alteraciones hemodinámicas, anemia y la extubación difícil. Con el tratamiento moderno la mortalidad es de 5% y suele atribuirse a arritmias cardiacas o tromboembolia pulmonar.


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