重症肌无力胸腺切除术后发生危象的原因及对策

目的探讨重症肌无力胸腺切除术后发生危象的原因及对策。方法回顾分析104例重症肌无力胸腺切除术的临床资料。结果术后发生危象18例(17·3%),其主要发生于术后早期,年龄>40岁、病程>12个月,Osserman临床分型属于Ⅲ型、Masqoka分期属于Ⅱ期、术前服用抗胆硷酯酶药物剂量>5mg/(kg·d)、术前曾发生危象和肺部感染、中度或重度通气功能障碍、手术时间>3h等是术后危象的最为常见诱因。对于术后发生危象的高危象患者,延迟气管插管、拔管要避免重插气管及减少气管切开;危象发生后及时行机械通气是抢救成功的关键。结论重症肌无力术后发生危象的因素甚多,应严格掌握手术适应证,并做好抢救准备。

The Causes and Treatment of Myasthenia Gravis Crisis after Thymectomy

Objective To review the causes and treatment of myasthenia gravis(MG) crisis after thymectomy.Methods A total of 104 patients with MG underwent thymectomy between 1990 and 2004,the risk of factors and treament methods of MG crisis after thymectomy were analyzed.Results Eighteen patients had crisis after thymectomy and one died,the risk factors included age,the course of disease, the clinical classification, crisis before operation ,operation time,the dosage of anticholinesterase drugs,the conditions of lung ventilation function , whereas the major cause of crsis is the postoperative infection of pulmonary.If crisis was predicated to occur after thymectomy,delayed extubation could decrease the need for reintubation and tracheotomy.Once the crisis occurred ,mechanical ventilation was the key to successful rescue .Improvement of respiratory care and cure of pulmonary infection were very helpful for crisis.Conclusion In MG patients after thymectomy,the causes of crisis is related to age,the course of disease, the clinical classification, crisis before operation ,operation time,the dosage of anticholinesteras drugs,the conditions of lung ventilation function.Mechanical ventilation early is of the most importance to sussessful rescuce.