重症肌无力术后延长拔管时间的临床价值

目的　探讨重症肌无力 (MG)胸腺切除术后 ,延长气管拔管时间 ,减少气管切开的价值。方法　回顾分析 1978年至 2 0 0 2年 12月行MG胸腺切除 2 36例 ,按时间分A组 :1996年 12月以前手术者116例 ,对术后可能发生肌无力危象的高危因素病人施行预防性气管切开 ;B组 :1997年后手术 12 0例 ,对具发生危象高危因素者采用延长气管拔管时间 ,并对两组危象发生率及气管切开率进行比较。结果　全组发生危象 4 4例 (18 6 % ) ,气管切开 4 6例 (ARDS 1例除外 )占 19 5 %。其中A组发生危象 2 3例(19 8% ) ,气管切开 34例 (2 9 3% ) ;B组发生危象 2 1例 (17 5 % ) ,气管切开 12例 (10 % )。两组危象发生率无明显差异 ,但A组的气管切开率明显高于B组 (P <0 0 0 1)。结论　对MG胸腺切除术后具发生危象高危因素病人 ,采用延长气管插管时间及辅助通气 ,可显著减少气管切开率。

The clinical efficiency of the delayed extubation for patients with myasthenia gravis after the extubation

Ovbective To study the efficacy of the delayed extubation as a valid method to avoid tracheostomy in patients with myasthenia gravis (MG patients) after thymectomy. Methods Two hundred and thirty-six MG patients underwent thymectomy in our department from 1978 to 2002 were retrospectively analyzed. 116 patients were operated on before December 1996,the prophylactic tracheostomy was performed in those with high risk factors for postoperative crisis. Another 120 patients were operated on after 1997,in those with high risk factors for postoperative crisis the delayed extubation was performed to avoid tracheostomy. The ratios of episodes of postoperative crisis and tracheostomy in the two different periods were statistically analyzed. Results Totally,there were 44 episodes of postoperative crisis (18.6%) and 46 episodes of tracheostomy (19.5%,excluding one case of ARDS). Before December 1996,there were 23 cases (19.8%) of postoperative crisis,34 cases of tracheostomy (29.3%). While after 1997,there were 21 cases (17.5%) of postoperative crisis,12 cases of tracheostomy (10%). Though the ratio of onsets of postoperative crisis varied insignificantly (P>0.05) in the two periods,the ratio of tracheostomy was significantly higher (P<0.001) before December 1996. Conclusion Delayed extubation seems efficient to avoid tracheostomy in MG patients with high risk factors for postoperative crisis.