硬膜外麻醉复合浅全麻应用于重症肌无力患者

重症肌无力 (Ｍｙａｓｔｈｅｎｉａｇｒａｖｉｓ ,ＭＧ)是一种神经肌肉接头部位乙酰胆碱受体减少、变性、坏死而导致神经传递障碍的自身免疫性疾病 ,临床表现为部分或全身横纹肌活动时疲乏无力 ,经休息或用抗胆碱酯酶药物后症状可缓解。其治疗主要是施行胸腺切除术。其麻醉关键在于防治呼吸危象的发生 ,术中尽可能不用神经肌肉传导及呼吸功能的药物 ,特别是肌松药。我们复习近几年来的国内外文献 ,总结采用硬膜外麻醉复合浅全麻的方法应用于 5例重症肌无力患者手术 ,效果满意 ,总结如下。1　资料与方法1.1　一般资料 :1995～ 2 0 0 1- 11的 …     

胸腺切除治疗重症肌无力53例

目的　探讨胸腺切除对重症肌无力的疗效。方法　对 1990年— 2 0 0 2年间手术治疗的 5 3例重症肌无力患者的临床资料和随访结果进行总结 ,并分析其预后因素。结果　疗效按Monden标准评价 ,缓解 14例 ( 2 6 4%) ,改善 2 4例 ( 4 5 3 %) ,无变化 9例 ( 17 0 %) ,恶化 6例( 11 3 %,其中死亡 2例 ) ,总有效率 (缓解 +改善 ) 71 7%。结论　胸腺切除术是治疗重症肌无力的有效方法 ,对重症肌无力病人应及早手术治疗。     

合并术前肌无力危象的重症肌无力临床特点和外科治疗

目的：探讨合并术前肌无力危象的重症肌无力临床特点和外科治疗。方法：分析18例合并术前肌无力危象的重症肌无力临床特点和外科治疗经验。并以同期手术的176例无术前肌无力危象患者为对照组进行比较。结果：两组患者手术前Osserman分期的构成比结构有明显差异（P=0．000）;与对照组比较,术前危象组术后发生肌无力危象的风险增加（OR=4．451）,术前危象组发生危象后机械通气时间明显延长（P=0．018）;术前危象组的各项呼吸肌强度相关肺功能指标均有明显下降。结论：术前合并肌无力危象的重症肌无力见于全身型患者,手术后再发危象风险增加,手术前积极控制症状,调整机体状态可以部分改善预后;手术后机械通气时问适当延长,严格掌握拔管指征。     

重症肌无力89例临床分析

目的 总结重症肌无力临床治疗经验。方法 分析89倒重症肌无力临床资料，其中药物治疗75例。合并胸腺瘸者行胸腺瘸切除术14倒。结果 药物治疗缓解11例。好转60例，无效4例。总有效率92％；手术治疗术后稳定缓解4例。药物缓解8例，无效2例。结论 重症肌无力是自身免疫性疾病，治疗包括药物治疗和手术治疗。本组病例治疗以药物为主，应用激素中剂量冲击小剂量维持疗法。联合抗胆碱酯酶药物治疗重症肌无力是有效的；伴有胸腺瘸者行胸腺切除术，胸腺切除术是治疗重症肌无力的有效手段。     

胸腺切除治疗重症肌无力的疗效分析

目的 评价67例重症肌无力患者胸腺切除术的治疗效果.方法 回顾性分析我院1995年12月～2004年12月期间67例行胸腺切除术的重症肌无力患者的临床资料,对其临床特点、手术方式、围手术期处理和治疗效果进行探讨.结果 按Monden标准评价疗效:缓解22例(32.8%),改善26例(38.8%),无变化14例(20.9%),恶化5例(7.5%),总有效率为71.6%.结论 胸腺切除术治疗重症肌无力疗效可靠,对重症肌无力患者应积极行胸腺切除术.     

重症肌无力39例的外科治疗

目的:总结重症肌无力采取胸腺瘤及胸腺增生切除术治疗经验,探讨重症肌无力合并胸腺瘤及胸腺增生的外科治疗。方法:对39例重症肌无力合并胸腺瘤及胸腺增生的外科治疗方法。结果:全组除死亡4例,2例死于肌无力危象,2例死于成人呼吸窘迫综合症外,其余31例随访1~6年,手术效果好。结论:重症肌无力是一种自身免疫性疾病,胸腺被认为是参与发病的重要组织,胸腺切除是治疗重症肌无力的有效方法,如能尽早手术治疗,将能获得较好的疗效。     

重症肺大疱的手术治疗分析

目的总结重症肺大疱的手术治疗经验。方法本组患者共计19例,男性15例,女性4例,术前根据影像学检查及辅助检查证实均属重症肺大疱。术前准备包括吸氧、抗感染、平喘、呼吸训练等。手术麻醉均采用双腔管、吸入加静脉复合麻醉。所有患者均常规开胸行标准肺大疱切除术,15例患者术后出现呼吸衰竭,给予辅助机械通气,1例患者行气管切开。结果19例患者痊愈出院,恢复期12~25d,术后自主症状及血气分析结果较术前均有明显改善。结论重症肺大疱患者术前病情重,掌握手术适应证十分重要;手术后发生呼吸衰竭的概率较高,应尽早给予辅助通气,多数患者恢复良好。     

手术治疗胸腺瘤并发重症肌无力13例分析

据相关文献[1]统计,有1/3以上的胸腺瘤患者并发重症肌无力,多需采取手术治疗,但围术期易发生各种危象导致死亡。1998年1月-2010年11月,我们采取手术治疗胸腺瘤并发重症肌无力13例。现分析报告如下。     

烧伤伴吸入性损伤行气管切开的抢救资料分析

 目的 探讨烧伤合并吸入性损伤患者行气管切开术的时机及并发症的预防和处理.方法 对96例烧伤合并吸入性损伤病患行气管切开观察其预后.结果 96例气管切开成功抢救91例,死亡5例,发生并发症18例(18.75%).烧伤后6 h内气管切开并发症发生率(14.3%)明显低于其他时间段,按照烧伤程度由重到轻的并发症发生率分别为25.0%、17.3%、15.0%.结论 头颈部烧伤合并吸入性损伤患者尽早行气管切开是抢救生命的重要而有效的手段.     

重症肌无力两种微创胸腺扩大切除术长期疗效比较

 目的 比较重症肌无力两种微创胸腺扩大切除术的长期疗效。方法 回顾性分析2010-06至2014-06原火箭军总医院采用两种微创方法行胸腺扩大切除术治疗的50例重症肌无力患者的临床资料及随访结果,两种术式的围术期结果比较采用χ²检验,远期疗效采用Kaplan-Meier法绘制有效率-时间曲线,log-rank法进行统计分析。结果 机器人组和胸腔镜组均顺利完成微创胸腺扩大切除术,均无中转开胸及围术期死亡。术后共发生肌无力危象4例(8.0%)。平均随访73.3个月,完全缓解率为34%(17/50),治疗总有效率为86.0%(43/50)。机器人组有效率和完全缓解率与胸腔镜组比较,差异无统计学意义。Osserman Ⅰ型有效率达100%,明显高于其他类型,差异有统计学意义(P<0.05)。性别、年龄、病理、手术方式和病程对5年累积有效率的影响无统计学意义。结论 胸腔镜和机器人胸腺切除术治疗重症肌无力安全、可行,长期疗效满意,两种术式对预后影响无统计学差异。     

Thymus irradiation for myasthenia gravis

Twenty-eight patients with progressive myasthenia gravis without thymoma received treatment of 3000 rads (30 Gy) to the anterior mediastinum, and a followup was conducted for five to 18 years. Twenty-four patients had generalized myasthenia, and four had ocular myasthenia gravis. Twenty patients with generalized myasthenia survived the several month post-treatment period and improved, but four died during that period. The improvement lasted a median of 1.5 years, and older patients had longer remissions than younger patients. The four patients who had ocular myasthenia did not change after treatment. Mediastinal irradiation produces a temporary remission in generalized myasthenia.     

CT-guided percutaneous ethanol injection of the thymus for treatment of myasthenia gravis

OBJECTIVE: This study was designed to validate the therapeutic effectiveness of CT-guided percutaneous ethanol injection of the thymus for the treatment of myasthenia gravis. SUBJECTS AND METHODS: The subjects were 45 patients with myasthenia gravis. The diagnosis was determined by the patients' histories, physical findings, neostigmine tests, and morphologic changes. According to the Osserman classification, the 45 patients with myasthenia gravis were classified as stage I (n = 26), stage III (n = 13), and stage IV (n = 6). A 21- or 22-gauge needle was inserted into the thymus under CT guidance, and then ethanol was injected step by step until it was distributed throughout the whole thymoma, the hyperplasia of the thymus, or the normal thymus. The amount of ethanol injected ranged from 2 to 13 mL, with a mean of 7 mL. RESULTS: CT follow-up at 3-4 weeks showed that the thymus or thymoma was completely or mostly necrotized. CT follow-up at 3 months showed that the vertical, transverse, and anteroposterior dimensions of the thymus in all 45 myasthenia gravis patients decreased by 59.2%, 68.6%, and 73.2%, respectively, compared with those before percutaneous ethanol injection treatment. The therapeutic effect was observable clinically 2 days after treatment in 44 patients, including 36 patients who were able to open their eyes after treatment. A 5-year follow-up study showed that the condition markedly improved in 35 patients, improved in nine patients, and failed to improve in one patient who did not respond to the treatment. After treatment, 37 patients presented with low-grade fever (range, 37.3-37.7 degrees C; mean, 37.5 degrees C), which resolved 3 days later without treatment; all 45 patients complained of mild retrosternal pain after ethanol injection. CONCLUSION: The therapeutic effect of CT-guided percutaneous ethanol injection into the thymus of patients with myasthenia gravis is definite. This procedure is safe and has low morbidity. CT-guided percutaneous ethanol injection is a minimally invasive alternative treatment for myasthenia gravis.     

What does radiologic diagnosis of the thymus gland accomplish in myasthenia gravis?

Radiologic imaging in myasthenia gravis is used for the evaluation of pathologic changes of the thymus gland. Computed tomography can demonstrate tumors of the anterior mediastinum in nearly 90% and is therefore superior to conventional radiography. Because of the variety of size and shape of the normal thymus gland, differentiation between normal thymus, follicular hyperplasia and thymoma is rarely possible especially in younger patients. In elderly patients with myasthenia gravis and involution of the thymus gland tumors of the thymus are reliably detected by computed tomography, whereas the ability of computed tomography to predict the histological diagnosis is poor even with intravenous administration of contrast media.     

微创条件下放射性~(125)I粒子组织间植入治疗非小细胞肺癌近期临床观察

目的观察多种微创条件下放射性125I粒子组织间植入治疗非小细胞肺癌的疗效。方法放射粒子植入治疗非小细胞肺癌81例,分别采取CT引导经皮穿刺、超声引导经皮穿刺、经纤维支气管镜、胸腔镜及小切口开胸等微创手段实现。结果手术全部成功。随访12～24个月,平均18个月。局部控制率82.3%。需要处理的气胸病人有3例。术后1例病人出现咯血。胸痛胸闷缓解率80%(45/56),咯血缓解率91%(16/18),阻塞性肺炎缓解率87%(15/17),上腔静脉综合征好转率96%(5/6)。结论微创条件下放射性125I粒子组织间植入治疗非小细胞肺癌是安全、有效的治疗方法。     

Radiologic detection of thymoma in patients with myasthenia gravis

From 1973 through 1986, 154 consecutive patients who had a transsternal thymectomy for myasthenia gravis had preoperative radiologic evaluation for a possible thymoma. Examinations included posteroanterior and lateral (n = 154) and shallow oblique (n = 126) chest radiography, linear tomography (n = 80), and chest CT (n = 96). At surgery, a thymoma was found in 26 patients (17%). Plain film findings, which often were subtle, correctly predicted a thymoma in 15 (58%) of 26 patients. CT findings correctly predicted a thymoma in 17 of 20 patients (sensitivity, 85.0%; specificity, 98.7%; and accuracy, 95.8%). CT findings failed to detect a thymoma in three patients because a small tumor was indistinguishable from adjacent thymus (n = 2) and respirator motion artifacts (n = 1). Four (15%) of the tumors were invasive, and three (12%) were calcified. The likelihood of a thymoma increased with increasing age (3% for 20 years old and under, 12% for 21-45 years old, and 35% for 46 years old and older). In the youngest group, the thymus is densely cellular and normally relatively large, and therefore a small thymoma may be hidden. In patients 21-45 years old, partial fatty involution leaves parenchymal islands that can mimic a thymoma or obscure a small tumor. In patients over 45 years old, fatty involution enhances recognition of even small thymic tumors. For all patients with myasthenia gravis, we recommend that the initial chest radiographic examination include posteroanterior, lateral, and shallow (20 degrees) oblique views. For those patients under 21 years old, we recommend chest CT only when local symptoms, signs, or radiographic findings suggest the presence of thymic abnormality. For those patients 21 years old and older, we recommend routine chest CT.     

High doses of immunoglobulin G in the therapy for severe forms of myasthenia gravis and Guillain-Barré syndrome

BACKGROUND/AIM: High doses of immunoglobulin G (IVIG) have been recognized as a very important therapeutic modality in the treatment of neurological diseases. The aim of this report was to present our experience in the treatment of severe forms of myasthenia gravis (MG) and Guillain-Barré syndrome (GBS). METHODS: We analyzed the efficacy and safety of immunoglobulin G therapy in 53 patients with severe forms of myasthenia gravis, and 27 patients with very severe forms of Guillain-Barré syndrome. RESULTS: At the end of the follow-up period, a significant improvement was noticed in 47 out of 53 patients with myasthenia gravis (88.7%). In the group of 27 patients with severe forms of Guillain-Barré syndrome an improvement was registered in 19 patients (70.3%). The side effects of this therapy were mostly mild, manifested as headache, myalgia, skin rash, adynamia, and other clinically insignificant effects. No severe side effects were recognized. CONCLUSIONS: Our study clearly demonstrated the high efficacy of IVIG therapy in the treatment of severe forms of myastehnia gravis and Guillain-Barré syndome.