胸腺瘤伴重症肌无力患者术后肌无力危象的临床分析

Clinical analysis of myasthenia crisis after thymectomy in patients with thymoma and myasthenia gravis

目的:探讨胸腺瘤伴重症肌无力(MG)患者行胸腺瘤切除术后,发生肌无力危象的影响因素及治疗措施。方法:48例胸腺瘤伴MG患者行扩大胸腺切除术,术后是否发生肌无力危象分组。分析肌无力危象与性别、年龄、病史、Osserman分型、胸腺瘤病理类型、Masaoka病理分期及术前用药关系,建立人工气道与机械通气治疗肌无力危象疗效。结果:18例患者于术后(1.69±1.62)d发生肌无力危象,肌无力危象与年龄、性别、Osser-man分型、病理类型、Masaoka分期及术前用药无关。9例气管切开、6例鼻腔气管插管、3例口腔气管插管,机械通气(12.0±13.88)d,肌无力危象组住院时间明显延长(34.61±23.90 d vs 20.33±15.26 d,P<0.05),10例给予大剂量激素冲击治疗,其中1例发生双侧股骨头坏死,无一例死亡。结论:胸腺瘤伴MG患者术后肌无力危象的发生与胸腺瘤关系不密切,迅速建立人工气道与合理的机械通气策略是救治肌无力危象的关键。

Objective： The purpose of this study was to explore the clinical characteristics and treatment of predict postoperatic myasthenic crisis after thymeetomy in patients with thymoma and myasthenia gravis. Method： 48 patients received thymectomy were analyzed retrospectively, 18 cases experienced myasthenic crisis and required mechanical ventilation. The following factors were evaluated： sex, age, disease interval, Osserman classification, pathologic type, Massoka pathologic staging and drugs treatment. The type of reintubation and effects of mechanical ventilation were analyzed. Result：The occurrence of myasthenic crisis was not assiciated with age, sex, Osserman classification, pathologic type,Masaoka staging, and drugs treatment. Most myasthenie crisis occurred at the early stage of postoperation （1.69±1.62 d）,trachea reintubation （9 cases） or tracheotomy （9 cases） with me chanical ventilation were needed for the treatment of myasthenic crisis. The duration of mechanical ventilation was 12.0 ± 13.88 days. Ten patients of myasthenic crisis received large doses of methylprednisolone treatment, no patient died. There was significant difference in hospital stay between with or without myasthenic crisis （34. 61± 23.90 d vs 20.33± 15.26 d, P 〈0.05）. Conclusion： In patients with thymoma and myasthenia gravis,the presence of thymoma should not be viewed as a positive prognostic factor regards as myasthenic crisis. Early intubation and mechanical ventilation may be the most important precedure in the management of myasthenia crisis.