重症肌无力患者胸腺切除术中无肌松麻醉技术的应用

Anesthesia for thymectomy in myasthenia gravis： non-muscle relaxant techniques

目的观察无肌松麻醉技术应用于重症肌无力（MG）患者胸腺切除术的安全性和可行性。方法选择拟行胸腺切除术的MG患者24例（Ⅰ～Ⅲ型），随机分为Ⅰ组和Ⅱ组，每组12例，Ⅰ组采用无肌松麻醉技术全身麻醉；Ⅱ组采用常规全身麻醉。结果两组患者均顺利插管，术中血流动力学稳定，两组平均动脉压（MAP）和心率（HR）比较差异无统计学意义；两组呼吸功能潮气量（VT）和脉搏氧饱和度（SpO2）与麻醉前比较，拔管后均受到一定影响，Ⅰ、Ⅱ组VT与麻醉前比较差异有统计学意义（P〈0．05或〈0．01），Ⅰ、Ⅱ组SpO2与麻醉前比较差异有统计学意义（P均〈0．01），两组拔管后比较差异亦有统计学意义（P〈0．05）；两组清醒和拔管时间比较差异有统计学意义（P〈0．05），Ⅰ组时间明显短于Ⅱ组；Ⅱ组术后2例出现肌无力危象。结论无肌松麻醉技术对MG胸腺切除术患者是一种安全、可靠的麻醉方法。

Objective To compare non-muscle relaxant anesthetic techniques and muscle relaxant anesthetic techniques in myasthenic patients undergoing thymeetomy, evaluating the safety and feasibility. Methods＇ Twenty-four consecutive myasthenic patients undergoing thymectomy were randomized in two groups ： group Ⅰ and group Ⅱ. Group Ⅰ adopted non-muscle relaxant anesthetic techniques and group Ⅱ adopted muscle relaxant techniques. Results Intubating conditions were good in all patients. There were no hemodynamic changes and at the end of the procedure the recovery was complete in all patients, there were no statistically significant in mean aortic pressure （MAP） and heart rate （HR） between two groups. There were statistically significant in tidal volume （VT） and SpO2 between pre-operation and past-operation （P 〈 0.05 or 〈 0.01 ）, VT and SpO2 of the post-operation in group Ⅰ were higher than those in group Ⅱ （P 〈 0.05 ）, the awake time and the extubate time were statistically significant （P 〈 0.05 ）, the time in group Ⅰ were shorter than that in group Ⅱ. All patients were extubated in the operating room but 2 patients had to be re-intubated for post-operative respiratory depression in group Ⅱ . Conclusion The non-muscle relaxant anesthetic technique is the safety and feasibility in myasthenic patients undergoing thymectomy.