胸腺瘤术后发生重症肌无力危象的呼吸道管理

Postoperative respiratory management of myasthenic crisis in patients received thymectomy

回顾性分析因重症肌无力(myasthenia gravis,MG)行胸腺切除术的86例患者的临床资料,结果显示危象预测积分<12分者,无危象发生;12-17分者,危象发生率为50.0％;18-23分者为70.0％;≥24分者为71.4％。术前危象积分≥12分者,术后24 h后拔除气管插管和行气管切开的患者百分率显著高于危象预测积分<12分者(分别为81.5％和63.0％vs20.3％和3.4％,p<0.01)。这提示MG患者危象预测积分≥12分者,术后需延迟拔除气管插管,若发生危象需长期呼吸机支持,才予以气管切开。

A total of 86 myasthenia gravis patients received thymectomy were reviewed retrospectively. There was no myasthenic crisis in patients with risk score under 12. The incidence of myasthenic crisis was 50. 0% in patients with risk score of 12-17, 70. 0% in patients with 18-23 and 71. 4% in patients with over 24. It is indicated that patients with myasthenia gravis should be extubated late if their risk score is over 12. If myasthenic crisis happened and the patients needed long term mechanical ventilation?tracheostomy should be performed.