重症肌无力胸腺摘除术的围手术期处理因素的分析

Factor Analysis of Perioperative Management of Myasthenia Gravis Having Undergone Thymectomy

目的 探讨围手术处理因素在治疗重症肌无力中的作用及其对手术后效果的影响。方法 回顾性分析 5 8例重症肌无力患者在临床分型、病理检查结果、围手术期抗胆碱酯酶药物剂量、辅助呼吸等方面对手术结果的影响。结果 手术后并发危象 9例 ,死亡 3例 ,辅助呼吸时间 (0～ 96 0h) ,平均 12 1h。气管切开 11例 ,纵隔感染 5例。术后随访的 4 9例中 ,症状完全缓解 4 0例 (81 6 % ) ,部分缓解 5 (10 2 % ) ,总缓解率 4 5 (91 8% )。结论 影响手术效果的主要原因是Os serman分型在Ⅱb 型以上 ,术前抗胆碱酯酶用药不规律 ,手术后有效的呼吸辅助类型的选择、呼吸道的管理及其肺部并发症防治 ,手术时机选择的恰当与否 ,有无合并胸腺肿瘤等因素。为防止术后出现猝发肌无力危象 ,可适时作气管切开 。

Objective To explore the importance and validity of perioperative management of myasthenia gravis having undergone thymectomy Methods There were retrospective analysis 58 cases patients with myasthenia gravis between affect of clinical type, pathological classify, assistant of ventilation, perioperative dosage of anticholinergic agents administration to result of operation Results There were complication of 9 myasthenic or cholinergic crisis, 3 death in hospital, duration of assistant ventilation arrange from 0～960 h, medial numerical valve is 121 h, 11 tracheostomy The full remission of smpotom was 40(81.6%), 5 portion remission(10.2%), 45 tolal remission(91.8%) Conclusion The main causes of effecting operation was no orderliness for anticholi nergic agents administration pre operation, selection of correct ventilation model, favorable respiratory manage and prevent from infection of pulmonary, not approprite oc casion for operation and accompanied with thymomas It is cognoscible that we should be strictly limit tracheostomy for patients, but, we should also adopt tracheostomy for myasthenic or cholinergic crisis immediately