重症肌无力104例患者围术期症状变化规律

Perioperative symptom changes of 104 cases of myasthenia gravis

目的探讨重症肌无力(myasthenia gravis,MG)患者围手术期的症状变化规律,为预防和降低MG患者手术风险提供理论依据。方法回顾性分析2015-2019年因MG于郑州大学第二附属医院胸外科行胸腺切除术的104例患者的临床资料。根据MG症状对机体生理及生活的影响程度,制定了"MG动态分型标准",按照MG症状轻重被划分为0~Ⅳ型;对每位患者入院时、术前和术后3个时间节点的症状按"动态分型标准"进行分型,分别统计入院时、术前、术后各型的例数。通过对每位患者型别改变情况进行统计分析,总结出MG患者围手术期症状变化规律。结果(1)入院时分型:0型12例,Ⅰ型42例,Ⅱ型32例,Ⅲ型12例,Ⅳa型5例,Ⅳb型1例。(2)术前分型:0型44例,Ⅰ型34例,Ⅱ型14例,Ⅲ型12例;术前症状减轻68例(65.4%,68/104),术前症状稳定36例(34.6%,36/104);无症状加重者。(3)术后分型:0型49例,Ⅰ型21例,Ⅱ型11例,Ⅲ型10例,Ⅳa型9例,Ⅳb型4例;33例(31.7%,33/104)术后症状较术前加重,在术后症状加重的患者中,术后第1天加重5例(15.2%,5/33),术后第2天加重9例(27.2%,9/33),术后第3天加重13例(39.4%,13/33),术后第4天加重4例(12.1%,4/33),术后第5天加重2例(6.1%,2/33)。结论MG患者入院时病情程度不一,经过个体化围术期处理后,半数以上患者症状不同程度减轻;手术后MG症状会因手术及麻醉影响出现一过性的症状加重现象,加重期多在术后第1~3天。合理选择低风险MG患者进行手术,避免术后加重期其他影响因素的叠加,有望减少MG患者术后危象的发生。

Objective To discuss the perioperative symptom change rule of patients with myasthenia gravis(MG),and to provide a theoretical basis for preventing and reducing the surgical risk of patients with MG.Methods The clinical data of 104 patients who underwent thymectomy in the Department of Thoracic Surgery of the Second Affiliated Hospital of Zhengzhou University from 2015 to 2019 were retrospectively analyzed.According to the degree of the impact of MG symptoms on the body's physiology and life,the"MG dynamic classification standard"was formulated,which was divided into type 0-typeⅣaccording to the severity of MG symptoms.The symptoms of each patient of"admission","preoperative"and"postoperative"are classified according to the"dynamic classification criteria",and the number of"admission","preoperative"and"postoperative"were counted respectively.Based on the statistical analysis of each patient's type changes,the perioperative symptom changes of myasthenia gravis patients were summarized.Results 1."Admission"classification:12 cases of type 0,42 cases of typeⅠ,32 cases of typeⅡ,12 cases of typeⅢ,5 cases of typeⅣa,and 1 case of typeⅣb.2."Preoperative"classification:44 cases of type 0,34 cases of typeⅠ,14 cases of typeⅡ,12 cases of typeⅢ;68 cases of preoperative symptom reduction(65.4%,68/104),36 cases of preoperative symptom stable(34.6%,36/104).Asymptomatic aggravation.3."Postoperative"classification:49 cases of type 0,21 cases of typeⅠ,11 cases of typeⅡ,10 cases of typeⅢ,9 cases of typeⅣa,4 cases of typeⅣb;33 cases(31.7%,33/104)had postoperative symptoms aggravated.Among the patients with worsening symptoms after surgery,5 cases(15.2%,5/33)worsened on the first day after surgery,9 cases(27.2%,9/33)worsened on the second day after surgery,and 13 cases(39.4%,13/33)worsened on the third day after surgery.There were 4 cases(12.1%,4/33)worsened on the 4th day,and 2 cases(6.1%,2/33)worsened on the 5th day after surgery.Conclusion MG patients had different conditions at admission.After individualized perioperative treatment,more than half of the patients'symptoms alleviated to varying degrees.After the operation,the symptoms of MG will be temporarily aggravated due to the effects of surgery and anesthesia,and the aggravation period is mostly on 1-3 days.Reasonable selection of low-risk MG patients for surgery,avoiding the superposition of other influencing factors in the postoperative exacerbation period,is expected to reduce the occurrence of postoperative crises in MG patients.