拟行胸腺扩大切除术的重症肌无力患者围术期应用泼尼松预防术后肌无力危象的效果

Effect of prednisone on prevention of postoperative myasthenic crisis in patients with myasthenia gravis undergoing extended thymectomy

目的探讨拟行胸腺扩大切除术的重症肌无力(myasthenia gravis,MG)患者围术期应用泼尼松预防术后肌无力危象的效果。方法选取2015年2月至2017年3月于首都医科大学附属北京天坛医院就诊并行胸腺扩大切除术的90例MG患者为研究对象,按照随机数字表法将其分为试验组和对照组,每组各45例。对照组患者手术前后常规服用胆碱酯酶抑制剂溴吡斯的明;在此基础上,试验组患者于术前3 d口服泼尼松,术后继续口服泼尼松2周。记录两组患者治疗效果和术后2周内(含2周)肌无力危象等并发症发生情况。采用生活质量核心问卷(quality of life questionnaire-core 30,QLQ-C30)评价两组患者术前和术后3个月的生活质量。结果两组患者疗效和术前QLQ-C30评分比较差异无统计学意义(均P>0.05)。术后2周,试验组患者肌无力危象发生率显著低于对照组(P<0.05),但两组患者感染、胸腔出血、声带麻痹和乳糜胸发生率比较差异均无统计学意义(均P>0.05)。试验组患者呼吸机辅助时间和术后拔管时间均显著短于对照组(均P<0.05)。术后3个月,两组患者QLQ-C30评分均显著高于本组术前(均P<0.05),但组间比较差异无统计学意义(P>0.05)。结论拟行胸腺扩大切除术的MG患者围术期应用泼尼松能够有效预防术后肌无力危象的发生,且对患者生活质量无不良影响。

Objective To investigate the effect of prednisone on prevention of postoperative myasthenic crisis in patients with myasthenia gravis(MG)undergoing extended thymectomy.Method A total of 90 patients with MG who underwent extended thymectomy in Beijing Tiantan Hospital Affiliated to Capital Medical University from February 2015 to March 2017 were randomly divided into experimental group(n=45)and control group(n=45).Patients in control group were routinely treated with brompistigmine before and after operation,on this basis,patients in experimental group were given prednisone 3 days before operation and continued to take prednisone for 2 weeks after operation.The therapeutic effect of the two groups and the occurrence of myasthenic crisis and other complications within 2 weeks after operation(including 2 weeks)were recorded.The quality of life of the two groups before and 3 months after operation was evaluated with the quality of life questionnaire-core 30(QLQ-C30).Result There were no significant differences in curative effect and preoperative QLQ-C30 score between the two groups(all P>0.05).Two weeks after operation,the incidence of myasthenic crisis in experimental group was significantly lower than that in control group(P<0.05),but there were no significant differences in the incidence of postoperative infection,thoracic hemorrhage,vocal cord paralysis and chylothorax between the two groups(all P>0.05).The ventilator assist time and postoperative extubation time in experimental group were significantly shorter than those in control group(all P<0.05).Three months after operation,the QLQ-C30 scores of the two groups were significantly higher than those before operation(all P<0.05),but there was no significant difference between the two groups(P>0.05).Conclusion Perioperative administration of prednisone in MG patients undergoing extended thymectomy can effectively prevent the occurrence of postoperative myasthenic crisis and has no adverse effect on the quality of life of the patients.