重症肌无力患者胸腺切除的麻醉临床观察

Clinical observation of anesthesia in thymectomy for myasthenia gravis

目的观察在重症肌无力(MG)胸腺切除中麻醉方法的安全性,并分析术后呼吸支持的影响因素。方法46例MG患者行胸骨正中劈开胸腺切除,术前口服平时用量溴吡斯的明;麻醉诱导用异丙酚、瑞芬太尼和琥珀胆碱;选用双腔支气管导管(DLT)插管,麻醉维持用氧、安氟醚和异丙酚复合瑞芬太尼。术中观察并记录患者在术前、切皮、劈断胸骨、切除胸腺和术毕各时点的血压(BP)、心率(HR)、血氧饱和度(SpO2)和呼吸末二氧化碳(PETCO2)。根据术后是否需要呼吸支持分成两组:术后立即拔管组(A组)和术后延迟拔管组(B组)。结果46例患者各个时点BP、HR、SpO2和PETCO2比较差异无统计学意义(P>0.05)。40例在手术室内成功拔管,拔管率为87.0%,6例术后需要呼吸支持2-9 h,术后延迟拔管率为13.0%,术后呼吸支持的患者随MG临床分级增加而增加。结论MG患者胸腺切除用异丙酚、瑞芬太尼和琥珀胆碱麻醉诱导,选用DLT插管,用氧、安氟醚和异丙酚复合瑞芬太尼麻醉维持,是一种安全的麻醉方法。

Objective To observe security of anesthesia method in thymectomy for myasthenia gravis,and to analyze the influential factors of postoperative support breath. Methods Forty-six adult patients with MG were thymeetomized by cleaving the breastbone. Before operation, the patients took the peacetime dose of pyridostigrnine bromide. Propofol, remifentanil and succinyl-choline chloride were injected for induction of anaesthesia. The patients were intubated with double-lumen endobronchial tube（DLT）. Oxygen,enflurane were inhaled,and propofol and remifentanil were injected for maintaininng the anesthesia effect. Blood pressure, heart rate, SpO2 and PETCO2 were observed and recorded before operation, at the times of cutting skin, cleaving breastbone and removing thymus, and after operation. They were divided into two groups according to breath support：non-support group and support group. Results BP, HR, SpO2 and PETCO2 had no significant difference at all time points（ P 〉 0.05）. Forty patients（87.0 % ） were successfully extubated at operating room. After operation, six patients（ 13.0 % ） needed breath support for 2 - 9 h. The numbers of patients with breath support increased as the clinical grade of myasthenia gravis increased. Conclusion It is a safe anaesthesia method in thymectomy with induction by injecting propofol, remifentanil and succinylcholine chloride, intubation with DLT, and maintenance with oxygen and enflurane, propofol and remifentanil.