300例重症肌无力患者胸腺切除手术的麻醉管理

Anesthetic Management for 300 Cases with Myasthenia Gravis Undergoing Thymectomy

目的分析300例重症肌无力(MG)患者胸腺切除手术的麻醉方式、探讨手术后需要呼吸支持的原因。方法随机选择2012年1月—2014年12月来该院进行治疗的300例重症肌无力胸腺切除术患者作为观察对象。根据患者术后是否需要呼吸机支持分为立刻拔管组266例和延迟拔管组34例,手术前给予溴吡斯的明口服,应用芬太尼、咪达唑仑、琥珀胆碱以及丙泊酚进行麻醉诱导,给予氧气、异氟烷以及氧化亚氮予以麻醉维持,不使用非去极化肌松剂。手术后8 h内小剂量给予溴吡斯的明,根据呼吸支持使用情况进行立即拔管或延迟拔管。回顾性分析患者的MG分型以及插管后的心率变化。结果两组患者的MG分型差异大(P<0.05);同时,两组患者插管后1、5、30 min的心率对比差异小(P>0.05);立刻拔管组的溴吡斯的明用量为(156.7±48.9)mg/d、明显少于延迟拔管组的(213.5±49.3)mg/d(P<0.05)。结论 MG患者实施胸腺切除术过程中做好麻醉诱导与麻醉维持,能够保证麻醉的安全性,延迟拔管的发生率随着患者MG分型的上升而增加。

Objective To analyze the anesthesia methods for 300 cases with myasthenia gravis（MG） undergoing thymectomy and investigate the reasons that require postoperative respiratory support. Methods 300 cases with MG underwent thymectomy in our hospital from January 2012 to December 2014 were selected as the subjects of observation and divided into the immediate extubation group（266 cases） and delayed extubation group（34 cases） in accordance with whether they needed postoperative respiratory support. Before surgery, the patients were given pyridostigmine bromide orally. The anesthesia was induced by fentanyl, midazolam, succinylcholine and propofol and maintained by administered oxygen, isoflurane and nitrous oxide without non-depolarizing muscle relaxant. Small-dose pyridostigmine bromide was given to the patients within 8h after the surgery. And immediate or delayed extubation was implemented in the patients in accordance with the use of respiratory support. A retrospective analysis was conducted on the MG typing and heart rate changes after intubation. Results The difference in the MG typing between the two groups was statistically significant（P0.05）. The difference in the heart rate 1 min, 5 min, 30 min after intubation was not statistically significant（P0.05）. The dosage of pyridostigmine bromide used in the immediate extubation group was much less than that used in the delayed extubation group [（156.7 ±48.9）mg/d vs（213.5±49.3） mg/d]（P0.05）. Conclusion Good anesthetic induction and maintenance for patients with MG undergoing thymectomy can ensure the safety of anesthesia. The incidence of delayed extubation in patients with MG increased with the rise of MG typing.