胸腺瘤切除术后重症肌无力危象的临床分析

The Clinical Features of Patients with Myasthenia Gravis Crisis after Thymectomy

目的:探讨胸腺瘤切除术后发生重症肌无力危象的原因及治疗方法。方法:回顾性分析1998～2005年诊治的14例胸腺瘤切除术后发生重症肌无力危象的患者的病例资料。结果:14例患者中1例死亡,其余治愈出院。重症肌无力危象主要发生于术后早期,Osserman临床分型属于Ⅲ型、Masqoka分期属于Ⅱ期、术前准备不充分,服用抗胆碱酯酶药物剂量较大、术前曾发生危象和肺部感染、中度或重度通气功能障碍等是术后发生危象的最常见诱因。结论:重症肌无力危象患者及时气管插管或气管切开,应用呼吸机,预防感染,肾上腺皮质激素冲击治疗,静脉注射大剂量免疫球蛋白等综合抢救措施,可明显缩短病程,显著降低死亡率。

Objective： To review the causes and treatment of myasthenia gravis （MG） crisis after thymectomy. Methods： 14 patients with myasthenia gravis crisis after thymectomy between 1998 and 2005 were evaluated in a retrospective study. Results： 14 patients had crisis after thymectomy and one died, the others were recovered. The risk factors included the course of disease, the clinical classification, crisis before operation, the dosage of anticholinesterase drugs,the conditions of lung ventilation function,whereas the major cause of crisis the postoperative infection of pulmonary. Once the crisis occurred,mechanical ventilation was the key to successful rescue. Improvement of respiratory care and cure of pulmonary infection were very helpful for crisis. Conclusions： The medicine treatment using intubation or tracheotomy with the positive pressure respiration , the hormone impact treatment,improvement of respiratory care and cure of pulmonary infection,the intravenous infusion of immunoglobulins substantially improved the prognosis of myasthenia gravis crisis, and decreased significantly the mortality.