重症肌无力胸腺切除术的麻醉探讨

Discussion on anesthesia of thymectomy for myasthenia gravis

目的 :探讨重症肌无力 (MG)病人胸腺切除术的麻醉处理。方法 :回顾性分析我院 1984～ 2 0 0 3年 6 2例MG病人行胸腺切除术 ,经口气管内插管 2 1例 ,经鼻气管内插管 4 1例。静吸复合方式维持麻醉。手术结束后带管回ICU进行呼吸治疗。结果 :2 1例经口气管内插管于术后 4～ 6h拔管 ,5例因肌无力危象反复发作须再次气管插管 ,4 1例经鼻气管内插管辅助呼吸延长到 6h至 5天后拔管 ,无一例再度行气管内插管。经鼻气管插管组与经口气管插管组相比 ,再插管例数明显少于经口组 ,两组相比差异有显著性 ;气管切开和死亡例数两组相比 ,无统计学差异。结论 :在MG病人行胸腺切除术的麻醉中 ,经鼻气管内插管有利于术后延长机械通气治疗 ,有效预防术后肌无力危象发生 ;充分术前准备 ,术中静吸复合维持麻醉 ,加强呼吸道管理是围术期的安全保障。

Objective:To investigate the anesthetic management of thymectomy for the patients with myasthenia gravis.Methods:Sixty-two patients with myasthenia gravis who underwent thymectomy in our hospital from 1984 to 2003 were retrospectively studied.Of these patients,21 cases received peroral endotracheal intubation and 41 cases pernasal intubation.Intravenous-inhalation combined anesthesia was taken during operation.All of 62 patients with endobronchial tube were transferred to ICU and received mechanical ventilation.Results:Twenty-one patients with perora endotracheal intubation were extubated at 4h-6h after operation.Of these 21 patients,five cases had to be intubated again because of repeated occurrence of myasthenia crisis.Forty-one patients with pernasal intubation did not extubated until mechanical ventilation for 6 hrs to 5 days,and none needed for intubation again,pernasal intubation cases were significantly different with peroral endotracheal intubation cases.The statistics have no difference betwen the trachea incisioned and the dead cases.Conclusion:In anesthetic management of thymectomy for the patients with myasthenia gravis,pernasal endotracheal intubation is convenient for prolonged mechanical ventilation,it can effectively prevent the occurrence of postoperative myasthenia crisis.The perioperative safety precautions,intravenous-inhalation combined anesthesia during operation and strengthening management of respriratory tract are very important.