重症肌无力行胸腺切除术后危象的防治(附98例分析)

Prevention and treatment of myasthenia gravis crisis after thymectomy:A report of 98 cases

目的:探讨重症肌无力行胸腺切除术后防治措施的改进,以改善预后。方法:我科1997-2002年因重症肌无力(myasthenia gravis,MG)行胸腺切除术的患者98例,分析其危象易发时间、危险因素及如何采取相应的防治措施。结果:术后发生危象14例,其中死亡1例。MG术后危象主要发生在术后早期,术后危象的发生与年龄、MG临床及病理分型、术前服用抗胆碱酯酶药物剂量、术前是否曾发生危象、肺通气功能和病程长短等危险因素有关,术后呼吸道感染是发生危象的最主要诱因。对于术后可能会发生危象的高危患者,须采用综合性防治措施,包括合理调整抗胆碱酯酶药及激素用量;术后危象发生后及时气管插管或气管切开行机械辅助通气是抢救成功、减少死亡的关键;而加强呼吸道管理、合理应用抗生素防治肺部感染可进一步改善危象的预后。结论:对术后可能发生危象的患者,应根据其危险因素采取相应措施,综合防治,有利于改善预后。

Objective:To improve study the prevention and treatment of myasthenia gravis(MG) crisis after thymecto-my. Methods;A total of 98 patients with MG underwent thymectomy between 1997 and 2002. The occurrence time.risk factors .prevention and treatment methods of MG crisis after thymectomy were analyzed. Results: Fourteen patients had crisis after thymectomy and one died. Most myasthenia gravis crisis occurred at the early stage of postoperation. The risk factors included age,the clinical and pathological classification, the dosage of anticholinesteras drugs,crisis before operation, the conditions of lung ventilation function and the course of the disease;whereas the major cause of crisis is the postoperative infection of respiratory system. If crisis was predicated to occur after thyectomy, the following prevention methods including adjusting the dosage of anticholinesteras and corticoid drugs should be taken. Once the crisis occurred, trachea reintubation or tracheotomy with mechanical ventilation is the key for successful rescue and low mortality. Improvement of respiratory care and cure of pulmonary infection were very helpful for crisis prognosis. Conclusion: In MG patients after thymectomy .prevention and treatment of MG should be taken according to the risk factors.