重症肌无力患者无肌松剂靶控输注麻醉的临床观察

A clinical evaluation of anesthesia for patients with myasthenia gravis using target controlled infusion without muscle relaxant

目的探讨无肌松剂靶控输注麻醉对重症肌无力患者胸腺切除术的安全性和可行性。方法选择重症肌无力患者31例,靶控输注效应室浓度异丙酚(3μg/mL)和瑞芬太尼(4ng/mL)诱导。待患者意识消失且两种药物均达到靶浓度后行气管插管。插管及术中均不使用肌松剂。观察血压心率变化、插管情况和术毕自主呼吸恢复、苏醒及拔管时间等。结果所有插管一次成功,38.7%(12例)的患者导管通过声门时有轻微咳嗽。插管后血压及心率与插管前比较显著升高(P<0.01)。术毕自主呼吸恢复的时间为(6.5±2.9)min,苏醒时间为(7.4±3.1)min,拔管时间为(9.8±3.6)min。观察期间未发现不良反应。结论重症肌无力患者用无肌松剂靶控输注麻醉安全有效,术毕呼吸功能恢复良好。

Objective To investigate the safety and feasibility of anesthesia for patients with myasthenia gravis using target controlled infusion without muscle relaxant.Methods Thirty-one patients with myasthenia gravis were recruited into study.A target controlled infusion was started with targeting effect-site concentration of propofol 3 μg/mL and remifentanil 4 ng/mL.Intubation was performed when patients were unconsciousness and target concentrations of both drugs were reached.No muscle relaxant was used during anesthesia.Blood pressure,heart rate,performance of intubation and respiratory recovery including extubation and wake time were observed.Results All patients were intubated successfully in one attempt.38.7% patients had mild cough when the endotracheal tube past through the vocal cord during intubation.Blood pressure and heart rate at post-intubation increased significantly as compared with pre-intubation （P0.01）.After cease of drugs,time of spontaneous breathing recovery was （6.5±2.9）min.Extubation and wakeup time were （9.8±3.6） and （7.4±3.1）min respectively.No adverse event was noted.Conclusion Target controlled infusion without muscle relaxant was safe and effective anesthesia for myasthenia gravis patients undergoing thymectomy.