重症肌无力患者的麻醉选择探讨

目的探讨重症肌无力(MG)患者胸腺切除术的麻醉处理方法和小剂量非去极化肌松药的应用,观察分析术后需呼吸支持的原因.方法36例MG病人诱导给予咪唑安定、芬太尼、丙泊酚和琥珀胆碱,经鼻腔气管插管.麻醉维持前期7例采用阿曲库铵和异氟醚,术后均带气管导管回监护室行呼吸支持.后期29例采用N2O和异氟醚.根据术后是否需要呼吸支持分成两组:术后立即拔管组和术后延迟拔管组.结果后期29例中24例在手术室内成功拔管,5例术后需呼吸支持12h至7d.结论MG患者行胸腺切除术,术中应用非去极化肌松药者,术后均需呼吸支持,吸入N2O O2和异氟醚,是一种安全的麻醉方法,术后需呼吸支持的发生率随MC的临床分级增加而增高.

Exploration on anesthesia choices for patients with myasthenia gravis

Objective To explore the methods of anesthesia for the thymectomy of patients with myasthenia gravis (MG) and the application of small-dose nondepolarized muscle relaxant and to observe and analyze the reasons for the need of postoperative respiratory support. Methods 36 MG patients Imidazole diazepam- fentanyl- propofol and succinylcholine were administered for inducement with nasal endotracheal intubation. Atracurium and isoflurane were adopted on 7 cases in the protophase of anesthesia maintenance. Respiratory support was conducted on all the 7 cases of the protophase who brought tracheal catheter with them to the monitoring unit. nitrous oxide and isoflurane on the 29 cases of the late phase were divided into the group of immediate postoperative decannulation and the group of delayed postoperative decannulation- according to whether needed respiratory support or not. Results Successful decannulation within the operating room occurred on 24 out of the 29 cases of the late phase- The other 5 cases needed respiratory support for 12 hours to 7 days. Conclusions All the patients who undergo thymectomy and use nondepolarized muscle relaxant during surgery need postoperative respiratory support. Inhalation of N20+02 and isoflurane is a safe method of anesthesia. The rate of respiratory support rises with the clinical grading aggravation of MG.