Objective To explore the influencing factors of respiratory failure in patients with myasthenia gravis and related factors of prognosis. Methods A total of 212 patients with myasthenia gravis were selected in the Second People's Hospital of Wuxi from February 2010 to February 2015,and they were divided into A group( complicated with respiratory failure,n = 104)and B group(did not complicated with respiratory failure,n = 108)according to the incidence of respiratory failure,and patients of A group were divided into A1 group(with good prognosis,n = 72)and A2 group(with poor prognosis, n = 32 ) according to the prognosis. Gender,age,course of myasthenia gravis,BMI,incidence of nosocomial infection, coronary heart disease,hypertension and diabetes,and usage of glucocorticoid were compared between A group and B group;pH,PaO2 ,PaCO2 ,serum levels of sodion and chloridion,incidence of nosocomial infection,and BMI were compared between A1 group and A2 group,and multivariate Logistic regression analysis was used to analyze the risk factors of respiratory failure in patients with myasthenia gravis and the risk factors of poor prognosis of myasthenia gravis patients complicated with respiratory failure. Results No statistically significant differences of gender or age was found between the two groups(P ﹥ 0. 05);the course of myasthenia gravis of A group was statistically significantly longer than that of B group,BMI of A group was statistically significantly lower than that of B group,while incidence of nosocomial infection,coronary heart disease,hypertension and diabetes,and using rate of glucocorticoid of A group were statistically significantly higher than those of B group(P ﹤ 0. 05). No statistically significant differences of PaO2 was found between the A1 group and A2 group( P ﹥ 0. 05);pH,serum levels of sodion and chloridion,and BMI of A1 group were statistically significantly higher than those of A2 group,while PaCO2 and incidence of nosocomial infection of A1 group were statistically significantly lower than those of A2 group ( P ﹤ 0. 05 ). Multivariate Logistic regression analysis showed that,long course of myasthenia gravis〔 OR = 0. 566,95% CI( 0. 118, 0. 854)〕,nosocomial infection〔 OR = 1. 021,95% CI( 1. 002,2. 109 )〕,low BMI〔 OR = 0. 630,95% CI( 0. 079, 0. 721)〕and using of glucocorticoid〔 OR = 1. 981,95% CI(1. 572,2. 548)〕 were risk factors of respiratory failure in patients with myasthenia gravis(P ﹤ 0. 05);low pH〔OR = 0. 761,95% CI(0. 235,0. 834)〕,high PaCO2 〔OR = 0. 779, 95% CI(0. 535,0. 935)〕,low serum sodion level〔 OR = 5. 230,95% CI(1. 634,8. 345)〕,low serum chloridion level〔OR = 9. 140,95% CI(1. 536,14. 456)〕,nosocomial infection〔 OR = 7. 653,95% CI(1. 034,13. 561)〕,low BMI〔OR = 9. 021,95% CI(1. 114,12. 452)〕 were risk factors of poor prognosis of myasthenia gravis patients complicated with respiratory failure(P ﹤ 0. 05). Conclusion The incidence of respiratory failure is related with course of myasthenia gravis, nosocomial infection,body nutrition status,usage of glucocorticoid and so on;acid - base imbalance,electrolyte disturbance, nosocomial infection and body nutrition status are related with the prognosis of myasthenia gravis patients complicated with respiratory failure.%目的：探讨重症肌无力患者并发呼吸衰竭的影响因素及其预后相关因素。方法选择无锡市第二人民医院2010年2月—2015年2月收治的重症肌无力患者212例，根据患者是否并发呼吸衰竭分为呼吸衰竭组104例（并发呼吸衰竭）和非呼吸衰竭组108例（未并发呼吸衰竭），根据预后情况将104例重症肌无力并发呼吸衰竭患者分为改善组72例和恶化组32例。比较呼吸衰竭组与非呼吸衰竭组性别、年龄、重症肌无力病程、体质指数、医院感染发生情况、合并症（冠心病、高血压、糖尿病）发生情况、糖皮质激素使用情况等；比较改善组与恶化组患者 pH 值、血氧分压和血二氧化碳分压、血清钠离子和氯离子水平、医院感染发生情况、体质指数等；采用多因素 Logistic 回归分析筛选重症肌无力患者并发呼吸衰竭的危险因素及重症肌无力并发呼吸衰竭患者预后不良的危险因素。结果呼吸衰竭组与非呼吸衰竭组患者性别、年龄比较，差异无统计学意义（P ﹥0.05）；呼吸衰竭组患者重症肌无力病程长于非呼吸衰竭组，体质指数小于非呼吸衰竭组，医院感染发生率、糖皮质激素使用率及合并症（糖尿病、高血压、冠心病）发生率高于非呼吸衰竭组（P ﹤0.05）。改善组患者 pH 值、血清钠离子和氯离子水平、体质指数高于恶化组，血二氧化碳分压、医院感染发生率低于恶化组（P ﹤0.05）；两组患者血氧分压比较，差异无统计学意义（ P ﹥0.05）。多因素Logistic 回归分析结果显示，重症肌无力病程长〔 OR =0.566，95% CI（0.118，0.854）〕、医院感染〔 OR =1.021，95% CI（1.002，2.109）〕、体质指数低〔 OR =0.630，95% CI（0.079，0.721）〕及使用糖皮质激素〔 OR =1.981，95% CI（1.572，2.548）〕是重症肌无力患者并发呼吸衰竭的危险因素（ P ﹤0.05）；pH 值低〔 OR =0.761，95% CI （0.235，0.834）〕、血二氧化碳分压高〔 OR =0.779，95% CI（0.535，0.935）〕、血清钠离子水平低〔 OR =5.230，95% CI（1.634，8.345）〕、血清氯离子水平低〔 OR =9.140，95% CI（1.536，14.456）〕、医院感染〔 OR =7.653，95% CI（1.034，13.561）〕、体质指数低〔OR =9.021，95% CI（1.114，12.452）〕是重症肌无力并发呼吸衰竭患者预后不良的危险因素（P ﹤0.05）。结论重症肌无力患者并发呼吸衰竭与重症肌无力病程、医院感染、机体营养状况及使用糖皮质激素等因素有关，重症肌无力并发呼吸衰竭患者预后与酸碱失衡、电解质紊乱、医院感染及机体营养状况有关。
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