重症肌无力危象的治疗和预防

Study on the Treatment and Prevention for Myasthenia Gravis Crises

目的 :探讨重症肌无力 ( myasthenia gravis,MG)病人围手术期中 MG危象发生的预防和治疗方法。方法 :对已收治的 2 1 0例 MG病人按时间顺序分为常规治疗组 ( A组 )和改良治疗组( B组 )。采用多相监测、选择性预防性气管切开和有效的药物治疗及改进的麻醉方法。结果 :A组病人 MG危象的发生率及死亡率明显高于 B组 ( P<0 .0 1 )。在 B组中应用上述方法及措施 ,降低了围手术期中 MG危象的发生率。结论 :对 MG病人在术前有效的药物治疗非常重要。术中、术后早期应用多相监测 ,及时了解病人生命体征变化 ,为及时治疗提供依据。对较危重的病人行胸腺切除 ,同时予以预防性气管切开和全身麻醉的改进有助于降低术后 MG危象的发生率及死亡率。

Objective: To study what measures may lower the morbidity of patients with myasthenia gravis (MG) crises in patients with MG. Methods:210 MG patients were divided into two groups according to the time of admission. Traditional treatment group(A group):67 patients during 1966-1991;Improved treatment group(B group):143 patients during 1992-2002.The morbidity of MG crises were contrasted before and after application of heterogeneous monitoring, selective tracheotomy in advance, effective medicine and improved anesthesia method. Results: The morbidity and mortality of MG crises in A group were far higher than those in B group ( P <0.01). Because of the application of heterogeneous monitoring, selective tracheotomy in advance, effective medicine and improved anesthesia method, the morbidity and mortality of MG crises in perioperative period in B group were lowered. Conclusion:The effective medicine before operation is very important, and heterogeneous monitoring is helpful in discovering the changes of vital index during operation and in the early stage after operation which might offer therapeutic basis for timely management, and tracheotomy in advance and improved anesthesia method are helpful in lowering the morbidity and mortality of MG crises in the perioperative period.