重症肌无力合并胸腺瘤患者围手术期的护理

重症肌无力合并胸腺瘤病例特点为病情较重,发展快,术前术后易出现危象,围手术期死亡率较高,预后欠佳。据资料显示,术后有35．5％的病人出现了MG危象,主要见于Ⅱb和Ⅲ型病例。术后在院死亡率为6．6％。随访结果为33．9％病人的MG症状得以治愈;21．1％病人的MG症状得以改善;5．8％病人症状同术前;36．2％病人死亡于该病。术后对患者提供专业的护理对于治疗重症病例非常重要,这也是降低围手术期死亡率有效的有效措施之一。本文通过对重症肌无力合并胸腺瘤患者的临床护理的分析。探讨对此类病人的有效护理方式。病人住院期间,应通过准确判断其病情变化,积极主动加强预见护性理,并做好患者的心理护理。     

在胸腺瘤合并重症肌无力患者中实施围术期护理的方式以及具体效果分析

目的 探讨在胸腺瘤合并重症肌无力患者中实施围术期护理的方式以及具体效果分析.方法 选取2017年3月至2019年5月我院收治的42例胸腺瘤合并重症肌无力患者作为研究观察的对象,运用随机分组法将患者分为对照组和实验组,每组各21例.对照组安排常规护理,实验组安排优质护理,研究分析两组胸腺瘤合并重症肌无力患者的不良反应发生...     

胸腺瘤合并重症肌无力的围手术期护理

重症肌无力是一种神经肌肉间传导功能发生障碍的自身免疫性疾病。研究表明，胸腺异常在重症肌无力的发病中有重要的作用，胸腺切除治疗重症肌无力有明确的效果。我院1997年1月-2006年12月共手术治疗胸腺瘤患者28例，其中合并重症肌无力13例，经精心护理，均好转出院，现将围手术期的护理体会报道如下。     

胸腺瘤合并重症肌无力的围手术期护理

重症肌无力是一种神经肌肉间传导功能发生障碍的自身免疫性疾病[1].研究表明,胸腺异常在重症肌无力的发病中有重要的作用,胸腺切除治疗重症肌无力有明确的效果[2].我院1997年1月-2006年12月共手术治疗胸腺瘤患者28例,其中合并重症肌无力13例,经精心护理,均好转出院.现将围手术期的护理体会报道如下.     

胸腺瘤与胸腺瘤合并重症肌无力的临床分析

目的:探讨胸腺瘤(TT)及胸腺瘤合并重症肌无力(TTMG) 临床特点.方法;对16年间外科治疗的TT129例,其中单纯TT84例(组1),TTMG45例(组2)的临床特点进行对比分析.结果:组1平均年龄36.6岁,最小年龄4岁,90.4%的病人肿瘤直径大于5cm,病理分期多为Ⅲ、Ⅳ期(66.2%).组2平均年龄45.2岁,最小年龄20岁,肿瘤直径3cm和5cm以下分别占34.6%和65.6%,55.2%为病理Ⅰ期.结论:早期胸腺瘤诊断标准为:肿瘸直径＜3cm和病理分期Ⅰ期;TTMG的特征是肌无力(MG)的症状重、病史短、症状进展快、胸腺危象的发生率高.     

胸腺瘤与胸腺瘤合并重症肌无力的临床分析

目的:探讨胸腺瘤(TT)及胸腺瘤合并重症肌无力(TTMG)的临床特点。方法:对16年间外科治疗的TT129例,其中单纯TT84例(组1),TTMG45例(组2)的临床特点进行对比分析。结果:组1平均年龄36.6岁,最小年龄4岁,90.4%的病人肿瘤直径大于5cm,病理分期多为III、IV期(66.2%)。组2平均年龄45.2岁,最小年龄20岁,肿瘤直径3cm和5cm以下分别占34.6%和65.6%,55.2%为病理I期。结论:早期胸腺瘤诊断标准为:肿瘤直径<3cm和病理分期I期;TTMG的特征是肌无力(MG)的症状重、病史短、症状进展快、胸腺危象的发生率高。     

胸腺瘤合并重症肌无力的手术治疗

目的:探讨胸腺瘤合并重症肌无力(MG)的手术方式、围术期处理及疗效。方法:观察分析近12年48例胸腺瘤合并重症肌无力手术患者的手术方式和围手术期处理方法及术后随访结果。结果:完整切除肿瘤36例,肿瘤大部分切除10例,仅作活检者2例。无围手术期死亡。术后发生肌无力危象12例(25.0%)。术后MG症状缓解24例(50.0%)。结论:手术是治疗胸腺肿瘤合并MG的主要方法,手术效果及预后与手术切除范围、病理分期等因素有关,围手术期处理是否恰当直接影响手术的安全。     

重症肌无力病人行胸腺切除术的护理

我院自1980～1996年采取胸腺切除治疗重症肌无力患者14例,现将护理体会总结如下。1临床资料本组14例中男6例,女8例,年龄最小者2岁,最大者64岁,按Menden改良的Dssrman分型,重症肌无力仅限无眼肌者为Ⅰ型,轻度累及全身者为ⅡA型,严重累及全身者为ⅡB型,急性暴发者为Ⅲ型。本组Ⅰ型2例,ⅡA型3例,ⅡB型5例,Ⅲ型4例。本组病程最短者25天,最长者15年。平均1年8个月,术前全部病人进行胸部X线正侧位片检查,发现有胸腺癌者3例。2护理体会2．1心理护理：本病病程长．有些患者生活不能自理,依赖药物维持活动,个别患者对手术信心不…     

62例重症肌无力胸腺切除术后危象的抢救及护理

目的:探讨分析重症肌无力行胸腺切除术后危象的抢救措施与护理方法。方法:对我科行胸腺切除术的62例重症肌无力患者的临床资料进行回顾性分析。结果:所有患者胸腺切除术都获得成功,无一例死亡。并发症的发生率为22.58%,重复插管率为8.06%。结论:重症肌无力患者行胸腺切除术之后容易发生术后并发症,须实施综合护理措施及加强围术期的呼吸道管理,才能有效预防术后危险的发生。     

平消胶囊对重症肌无力合并胸腺瘤的临床疗效观察

目的：观察平消胶囊治疗重症肌无力合并胸腺瘤的临床疗效及安全性。方法：应用临床评分方法观察平消胶囊治疗78例、环磷酰胺治疗75例患者重症肌无力病情改善情况及副作用。结果：治疗结束时有效率平消胶囊组为87.18%,环磷酰胺组为78.67%,两组组相比较有显著性差异（P〈0.05）,毒副作用平消胶囊组明显小于环磷酰胺组（P〈0.05）。结论：应用平消胶囊治疗重症肌无力合并胸腺瘤能有效改善重症肌无力患者临床症状,毒副作用小,安全性可靠。     

Protective effect of Sijunzi decoction on neuromuscular junction ul- trastructure in autoimmune myasthenia gravis rats

OBJECTⅣE： To investigate the protective role of Sijunzi decoction in neuromuscular junction（NMJ）and muscle cell mitochondria ultrastructure; as well as its effects on the amount of adenosine triphosphate（ATP） and the activities of mitochondrial respiratory chain complexes I, Ⅱ, Ⅲ, and Ⅳ in autoimmune myasthenia gravis rats.METHODS： An experimental autoimmune myasthenia gravis（EAMG） rat model was established by inoculating rats with acetylcholine receptors extracted from Torpedo. Rats were divided into three groups： model, prednisone, and Sijunzi decoction, and were fed physiological saline, prednisone, or Sijunzi decoction, respectively. NMJ and muscle cell mitochondria ultrastructure were observed by transmission electron microscope. The amount of ATP was assessed by high performance liquid chromatography. The activities ofmitochondrial respiratory chain complexes I, Ⅱ, Ⅲ,and Ⅳ was determined using the Clark oxygen electrode method.RESULTS： In the model group, there were sparse muscle fibers, with decreased mitochondria, and sparse, diffluent, or absent NMJ folds. After intervention with Sijunzi decoction, the above pathology changes were improved： muscle fiber structure was clear and complete; the mitochondria count was higher; and the NMJ structure was close to normal. Gastrocnemius muscle mitochondria in the model group produced significantly less ATP than those in the prednisone group（P0.01）. Conversely, the ATP of Sijunzi decoction group was significantly higher than prednisone group（P0.01）. The activities of gastrocnemius muscle mitochondrial respiratory chain complexes I, Ⅱ, Ⅲ, and Ⅳ in both the prednisone and Sijunzi decoction groups was dramatically higher compared with the model group（P0.05）. The activities of complexes I and Ⅲ in the Sijunzi decoction group were significantly higher than those in the prednisone group（P0.05）, but there was no obvious difference in complex Ⅱ or Ⅳ activities between the two groups（P0.05）.CONCLUSION： Sijunzi decoction improved pathological changes in muscle mitochondria and NMJ,enhanced the amount of ATP in gastrocnemius muscle mitochondria, and improved the activities of respiratory chain complexes I, Ⅱ, Ⅲ, and Ⅳ（especially I and Ⅲ） of the EAMG rats.     

张怀亮教授治疗重症肌无力经验

重症肌无力是神经肌肉突触传递功能障碍的一种疾病,张怀亮教授认为治疗本病关键要把握该病的特征,辨证施治,使正气得以速复,肌力增强,脾、肝、肾的亏虚得以充盈,同时注重通过心理辅导提高患者的心理承受能力,这对提高患者的抗病能力,加速康复也是一个很重要的环节。     

重症肌无力中医治疗研究进展

本文综述了近十年中医治疗重症肌无力的临床研究进展.分型辨证论治中,以从脾胃、脾肾及肝(肝肾)着手治疗为主.在临床探索中也形成了许多固定验方,采用针灸疗法治疗者也不在少数,疗效均明显.但关于基础理论的研究不多,尤其对于中药治疗本病的具体机制缺乏深入的研究.且存在研究设计不够严谨、中医辨证分型标准不统一、疗效评定标准不统一、西医分型与中医辨证未统一等问题.     

健脾强肌汤联合康复训练对重症肌无力患者免疫功能及症状改善的研究

目的观察健脾强肌汤联合康复训练对重症肌无力患者免疫功能及症状改善的疗效。方法将81例重症肌无力患者随机分为2组,对照组39例予溴吡斯的明联合醋酸泼尼松片治疗,治疗组42例在对照组治疗基础上加健脾强肌汤联合康复训练治疗。2组均治疗3个月后统计疗效。检测2组治疗前后外周血T淋巴细胞亚群(CD3~+、CD4~+、CD8~+、CD4~+/CD8~+)及自然杀伤(NK)细胞水平变化情况,并采取四分五级计分法对肌力状况评分进行比较。结果治疗组总有效率85.71%,对照组总有效率74.36%,比较差异有统计学意义(P0.05),治疗组总有效率高于对照组。2组治疗后CD3~+、CD4~+、CD4~+/CD8~+及各项肌力评分均较本组治疗前下降,CD8~+、NK细胞水平升高,比较差异均有统计学意义(P0.05)。2组治疗后组间比较显示,CD4~+、CD8~+、CD4~+/CD8~+及NK细胞水平、各项肌力评分比较差异均有统计学意义(P0.05)。结论健脾强肌汤联合康复训练治疗重症肌无力疗效显著,可明显提高各项肌力评分,纠正免疫系统T淋巴细胞亚群失衡,疗效持久稳定。     

基于脾肾亏虚相关研究探讨重症肌无力的治疗

本文基于中医、实验等研究脾肾亏虚的相关性探讨重症肌无力治疗的中西医结合理论基础.中医认为,重症肌无力在中医临床多以虚证辨证而治,与脾肾关系最为密切.实验证明,通过补脾健肾法可改变脾肾亏虚型动物模型或患者的ATP、肌糖原、脂肪含量以及骨骼肌细胞缺氧及线粒体结构等更好的协调免疫应答改善脾肾亏虚症状.     

针药并用治疗眼型重症肌无力

本文简要阐明了我科近两年来针药并用治疗眼型重症肌无力的方法及临床疗效观察.其中针灸以阳白、攒竹、鱼腰、合谷、百会、精明、风池等为主穴,行补法以益气升提,配合中药滋补脾肾、健脾益气,共治疗3例眼型重症肌无力患者,均获痊愈.     

Protective effect of Sijunzi decoction on neuromuscular junction ultrastructure in autoimmune myasthenia gravis rats

Objective

To investigate the protective role of Sijunzi decoction in neuromuscular junction (NMJ) and muscle cell mitochondria ultrastructure; as well as its effects on the amount of adenosine triphosphate (ATP) and the activities of mitochondrial respiratory chain complexes I, II, III, and IV in autoimmune myasthenia gravis rats.

Methods

An experimental autoimmune myasthenia gravis (EAMG) rat model was established by inoculating rats with acetylcholine receptors extracted from Torpedo. Rats were divided into three groups: model, prednisone, and Sijunzi decoction, and were fed physiological saline, prednisone, or Sijunzi decoction, respectively. NMJ and muscle cell mitochondria ultrastructure were observed by transmission electron microscope. The amount of ATP was assessed by high performance liquid chromatography. The activities of mitochondrial respiratory chain complexes I, II, III, and IV was determined using the Clark oxygen electrode method.

Results

In the model group, there were sparse muscle fibers, with decreased mitochondria, and sparse, diffluent, or absent NMJ folds. After intervention with Sijunzi decoction, the above pathology changes were improved: muscle fiber structure was clear and complete; the mitochondria count was higher; and the NMJ structure was close to normal. Gastrocnemius muscle mitochondria in the model group produced significantly less ATP than those in the prednisone group (P<0.01). Conversely, the ATP of Sijunzi decoction group was significantly higher than prednisone group (P<0.01). The activities of gastrocnemius muscle mitochondrial respiratory chain complexes I, II, III, and IV in both the prednisone and Sijunzi decoction groups was dramatically higher compared with the model group (P<0.05). The activities of complexes I and III in the Sijunzi decoction group were significantly higher than those in the prednisone group (P< 0.05), but there was no obvious difference in complex II or IV activities between the two groups (P>0.05).

Conclusion

Sijunzi decoction improved pathological changes in muscle mitochondria and NMJ, enhanced the amount of ATP in gastrocnemius muscle mitochondria, and improved the activities of respiratory chain complexes I, II, III, and IV (especially I and III) of the EAMG rats.     

王宝亮教授治疗重症肌无力验案三则

王宝亮教授,一位名中医,临证30余载,擅长中西医结合治疗脑血管病、运动神经元病、多发性硬化。近年来专注于重症肌无力的临床研究,疗效显著。兹将王师在临床中治疗重症肌无力之验案三则进行了总结。     

金实运用虫类药从络辨治重症肌无力经验

结合络病理论,通过典型案例探讨金实运用虫类药辨治重症肌无力经验。通过整理分析金实治疗重症肌无力的临床医案,归纳总结金实的辨证思路及治疗特色。金实认为重症肌无力属中医痿证范畴,治疗上强调从络辨证施治,不拘泥于补益气血之法,随证化裁,临床疗效较好。     

张静生教授治疗重症肌无力临床经验举隅

张静生教授在长期的临床实践基础上,提出重症肌无力病因病机以脾肾亏虚为主。诊治时根据其病因病机特点,而立"补脾益肾升阳"为治疗大法,并将补脾益肾升阳中药治疗贯穿于病程的始末,辨证施法,随证用药,收到了很好的临床疗效。