重症肌无力患者胸腺切除术围手术期重症肌无力危象的危险因素分析

Analysis of risk factors of myasthenia gravis crisis in myasthenia gravis patients during perioperativeperiod for thymectomy

目的探讨重症肌无力(MG)患者胸腺切除术围手术期并发肌无力危象的危险因素。方法收集63例MG患者的临床资料,按照围手术期是否发生肌无力危象,分为发生危象组和未发生危象组,分析肌无力危象的危险因素。结果本组发生肌无力危象12例(19.0%)(发生危象组),未发生肌无力危象51例(81.0%)(未发生危象组)。与发生危象组比较,未发生危象组Osserman分型、术式、手术时间、术中出血量及病理类型差异有统计学意义(P<0.05~0.01)。多变量Logistic回归分析显示,Osserman分型(Ⅱb+Ⅲ型)、手术时间(>3 h)、术中出血量(>100 ml)以及病理类型(侵袭性胸腺瘤)是肌无力危象的独立危险因素(OR=55.257,95%CI:7.953~383.909,P=0.000;OR=105.243,95%CI:8.570~1292.357,P=0.000;OR=14.008,95%CI:2.597~75.559,P=0.002;OR=18.552,95%CI:4.368~78.789,P=0.000)。结论 Osserman分型Ⅱb+Ⅲ型、手术时间>3 h、术中出血量>100 ml以及侵袭性胸腺瘤是胸腺切除术围手术期并发肌无力危象的独立危险因素。充分的术前评估准备、减少术中出血及缩短手术时间有助减少肌无力危象发生。

Objective To investigate the risk factors of myasthenia gravis crisis in myasthenia gravis （MG） patients during perioperative period for thymeetomy. Methods The clinical data of 63 MG patients were collected. In according with whether suffering myasthenia crisis during perioperative period for thymectomy or not, patients were divided into crisis group and non-crisis group. The risk factors of MG crisis were analyzed. Results Twelve patients had myasthenia crisis （ 19.0% ） （ crisis group） , and 51 cases （ 81% ） didn＇t have myasthenia crisis （ non-crisis group）. Compared with crisis group, Osserman classification, incision approach, operation time, volume of blood lost and thymus pathology in non-crisis group had statistical significance （ P 〈 0.05 - 0.01 ）. Logistic regression multivariate analysis showed Osserman classification （ Ⅱ b ＋ Ⅲ type）, operation time （ 〉 3 h）, volume of blood lost （ 〉 100 rnl） and thymus pathology （ invasive thymoma） were independent risk factors for myasthenic crisis （ OR = 55. 257, 95% CI： 7. 953 - 383. 909, P = 0. 000 ; OR = 105. 243, 95% CI： 8. 570 - 1292. 357, P = 0. 000 ; OR = 14. 008, 95% CI： 2. 597 -75. 559, P =0. 002; OR = 18. 552, 95% CI. 4.368 -78. 789, P =0. 000）. Conclusions Osserman classification （Ⅱ b ＋ Ⅲ type） , operation time （ 〉 3 h）, volume of blood lost （ 〉 100 ml） and thymus pathology （invasive thymoma） are independent risk factors for myasthenic crisis in MG patients during perioperative period for thymectomy. Adequate preoperative preparation, to minimize blood loss and shorten the operation time will help to reduce the incidence of myasthenic crisis.