胸腺切除术后并发重症肌无力危象的救治经验总结

Experience Summarization of Treatment of Myasthenia Gravis Crisis After Thymectomy

目的探讨重症肌无力(MG)患者胸腺切除术后并发重症肌无力危象(MC)的有效救治措施。方法回顾性分析2007年1月—2015年8月皖南医学院弋矶山医院重症医学科收治的胸腺切除术后并发MC的6例患者的诱因、救治方法及转归。结果 4例因发生肺部感染诱发MC,其中1例患者经治疗好转脱机拔管后因肺部感染再次加重诱发反拗危象;未遵医嘱服药诱发1例;另外1例患者术后无明显诱因发生MC。6例患者均在抗感染治疗同时给予嗅吡斯的明片口服、盐酸戊乙奎醚注射液肌肉注射及糖皮质激素冲击治疗,均行气管插管机械辅助通气治疗,并采用无创头盔式面罩实施有创-无创序贯脱机模式顺利脱机。患者经过积极救治后均预后良好康复出院。结论 MG患者胸腺切除术后易并发MC,及早机械通气治疗并准确把握有创-无创序贯通气切换,加强呼吸道管理及合理用药可提高救治成功率,改善预后。

Objective To investigate the effective treatment for myasthenia gravis（ MG） patients with myasthenia gravis crisis（ MC） after thymectomy. Methods From January 2007 to August 2015,six cases with MC after thymectomy who were treated in Department of Critical Care Medicine of Yijishan Hospital,Wannan Medical College,the incentive,treatment experience and prognosis were analyzed retrospectively. Results MC of four patients was triggered by pulmonary infection,among them one improved after treatment, but pulmonary infection got worse after taking away the tube of the life support machine,which triggered brittle crisis; MC of one patient was triggered by not taking medicine according to the instruction,MC of the other one had unclear cause. The six patients were treated by anti- infection treatment at the same time give the pyridostigmine bromide tablets, penehyclidine hydrochloride injection muscle injection and glucocorticoids impact treatment,tracheal intubation and mechanical ventilation,and non- invasive helmet mask was used to realize the switching between the invasive ventilation and non- invasive ventilation. After treatment, all MC cases recovered well and were discharged from hospital,the prognosis was good. Conclusion Patients with MG after thymectory may suffer from MC, early mechanical ventilation and accurate invasive- noninvasive sequential switching ventilation,strengthening the respiratory tract management and rational use of medicines can improve the treatment success rate and improve the prognosis.