重症肌无力术后发生肌无力危象的危险因素分析

目的分析重症肌无力术后发生肌无力危象的影响因素。方法回顾性分析2006年6月至2019年6月首都医科大学宣武医院胸外科65例重症肌无力术后发生肌无力危象患者的临床资料,其中男31例(47.7%)、女34例(52.3%),年龄15~78(45.7±17.8)岁。分析患者的手术方式、手术时间、病理类型等与术后发生肌无力危象的关系。结果手术时间、病理类型是术后肌无力危象的影响因素。Osserman分型的受试者工作特征曲线下面积(AUC)为0.676,临界值为ⅡB型,灵敏度37.5%,特异性90.5%,约登指数0.280。Masaoka分期的AUC为0.682,临界值为Ⅱ期,灵敏度62.5%,特异性66.7%,约登指数0.292。出血量的AUC为0.658,临界值为90 mL,灵敏度87.5%,特异性69.6%,约登指数0.304。结论术前Osserman分型、病理类型、手术时间、出血量是发生术后肌无力危象的影响因素,因此充分的术前准备、快捷仔细的术中操作和积极的术后处理可减少术后肌无力危象的发生。

Analysis of risk factors of myasthenia crisis after thymectomy in patients with myasthenia gravis

Objective To analyze the risk factors of myasthenia gravis crisis after thymectomy with myasthenia gravis(MG).Methods Sixty-five myasthenia gravis patients who had myasthenia crisis after thymectomy in Xuanwu Hospital,Capital Medical University from June 2006 to June 2019 were retrospectively enrolled,including 31 males and 34 females,aged 15-78(45.7±17.8)years.The relationship between myasthenia crisis after thymectomy and surgical option,operation time,pathological type,et al.were anylyzed.Results Operation time and pathological type were the predictive factors of postoperative myasthenic crisis.The area under receiver operating characteristic curve(AUC)of MG type(Osserman)was 0.676,the cut-off value wasⅡB type,the sensitivity was 37.5%,the specificity was 90.5%,and the Youden’s index was 0.280.The AUC of thymoma stage(Masaoka)was 0.682,cut-off value was stageⅡ,sensitivity was 62.5%,specificity was 66.7%,and Youden’s index was 0.292.The AUC of blood loss was 0.658,the cut-off value was 90 mL,the sensitivity was 87.5%,the specificity was 69.6%,and the Youden’s index was 0.304.Conclusion Preoperative MG classification,pathological type,operation time and blood loss are the risk factors of postoperative myasthenic crisis.Therefore,adequate preoperative preparation,rapid and careful intraoperative operation and active postoperative management can reduce the occurrence of postoperative myasthenic crisis.