重症肌无力胸腺切除术后呼吸道管理与并发症的防治

Postoperative Respiratory Management and Complications Prevention after Thymectomy in Patients with Myasthenia Gravis

目的 探讨重症肌无力胸腺切除术后呼吸道管理与并发症的防治。方法 32例ICU收治的重症肌无力胸腺切除术后的患者，根据危象预测积分，分为普通组（积分〈12分，n=21）和高危组（积分〉12分，n=11），对两组患者术后呼吸机支持时间、拔管前后肌力恢复情况、自主呼吸情况、动脉血气分析情况以及两组患者术后体温、胸片和痰培养结果进行统计分析。结果 高危组患者术后呼吸支持时间（18～30h，平均26h）大于普通组患者（4～28h，平均14h），两组有显著性差异（P〈0．01），同时术后发热、胸片渗出影以及阳性痰培养结果的发生率也高于普通组。结论 术后给予高危患者严密的监测和充分的呼吸支持，有助于降低重症肌无力危象的发生率和死亡率，同时应充分重视气道护理和感染的防治。

Objective To evaluate the methods of postoperative respiratory management and complications prevention of patients with myasthenia gravis who received thymectomy. Methods According to the accumulated scores of myasthenic crisis prediction, the patients with myasthenia gravis who underwent thymectomy in the past 5 years were divided into 2 groups： high risk group（ 〈12, n =21） and control group （ 〉12, n =11）. The time of mechanical ventilation, restoration of muscle strength and spontaneously breathing during extubation, results of arterial blood gas analysis, body temperature, chest X-ray examination and sputum culture of each patient were analyzed. Results The time of mechanical ventilation in high risk group （18-30 h, 26 h in average） was longer than that in control group（4--28 h, 14 h in average）（P 〈0.01）. Meanwhile, The incidence of fever, chest exfiltration and positive result of sputum culture in high risk group we.re also higher than that in control group. Conclusion Meticulous postoperative care and sufficient breath support should be carried out for high risk patients to diminish the incidence and mortality rate of postoperative myasthenic crisis. At the same time, the airway management and infection prevention should be emphasized.