一次性腹带加压包扎止痛法预防重症肌无力术后肺部并发症的效果观察

目的探讨一次性腹带加压包扎止痛法减轻重症肌无力病人术后伤口疼痛,促进有效咳嗽排痰,减少肺部并发症的效果。方法将180例接受扩大范围胸腺切除术的病人按照随机数字表将他们随机分配到观察组和对照组各90例。观察组术后第1天病人胸部伤口予一次性腹带加压包扎至术后5d拆除。其余两组病人均指导有效咳嗽排痰的方法,病人均在口服吡啶斯的明后30min时协助咳嗽排痰。结果观察组病人术后咳嗽排痰有效率明显高于对照组,术后并发症的发生率低于对照组。观察组病人无胸部不适,上肢血运不良,呼吸不畅等不适。结论重症肌无力病人术后伤口采用一次性腹带加压包扎止痛法能有效减轻病人因咳嗽排痰引起的伤口疼痛,促进病人敢于深呼吸及咳嗽排痰,有效预防肺部并发症,促进病人康复。

胸腺瘤切除术后发生重症肌无力的危险因素分析

目的探讨胸腺瘤切除术后发生重症肌无力(myasthenia gravis,MG)患者的危险因素。方法回顾性分析新疆医科大学第一附属医院2002年6月至2015年5月行胸腺肿瘤切除术126例患者的临床资料,其中男51例、女7 5例,年龄31~73(51.71±14.06)岁。所有患者术前均无MG,术后病理确诊为胸腺瘤。分析患者术后发生MG的相关因素。结果 9例患者术后出现MG(7.1%)。不完整切除(P=0.024)、病理类型(P=0.048)、合并免疫疾病(P=0.024)、术后肺部感染(P=0.036)为术后发生MG的危险因素,术中未能完整切除者或侵袭性胸腺瘤术后放化疗(P=0.011)可降低术后MG的发生风险。结论肿瘤不完整切除、WHO病理分型A型和AB型、伴随免疫疾病、术后肺部感染患者行胸腺瘤切除术后易发生MG,术中未能完整切除者或侵袭性胸腺瘤术后应行放化疗。

Long-term prognostic analysis of thymectomized patients with myasthenia gravis

OBJECTIVE: To study the factors affecting the long-term prognosis of patients with myasthenia gravis (MG) after thymectomy. METHODS: 170 MG patients who had undergone thymectomies were studied retrospectively. Among them, 124 patients received long-term follow-up for more than 40 months postoperatively. The COX regression analysis model was used to analyze the factors that may influence the long-term prognosis. These factors included thymus pathology, patient gender, age, duration of disease at the time of surgery, preoperative Osserman classification and medication. RESULTS: The research showed that thymus pathology was the single independent factor that affected the postoperative long-term prognosis. The long-term survival rates differed significantly with thymus pathological types: hyperplasia > benign thymoma > atrophy > malignant thymoma (P