Study of measures to lower perioperative mortality of patients with myasthenia gravis

目的 :探讨降低重症肌无力 (MG)病人围手术期中的 MG危象发生率和死亡率及哪些方法行之有效。方法 :对已收治的 1 67例 MG病人按时间顺序进行了分组研究。对比采用多相监测、选择性预防性气管切开和改进麻醉方法前后围手术期 MG危象的发生率及死亡率。结果 :在第一组中 ,由于缺少多相监测、预防性气管切开和麻醉方法的改进 ,使之其 MG危象的发生率及死亡率明显高于第二组 (P<0 .0 1 )。在第二组中应用上述方法及措施 ,提高了治疗和护理水平 ,降低了围手术期中 MG危象的发生率及死亡率。结论 :对 MG病人在术中、术后早期应用多相监测 ,可以及时了解到病人生命体征变化 ,为及时处理提供治疗依据 ;对较危重的病人行胸腺切除 ,同时予以预防性气管切开及术后早期予以短时间的呼吸支持和诱导麻醉应用小剂量非去极化肌松药 ,术中麻醉维持以氯胺酮为主 ,间断吸入氧化亚氮和氨氟醚或异氟醚 ,术中保持自主呼吸 ,有助于降低术后MG危象的发生率及死亡率

Study of measures to lower perioperative mortality of patients with myasthenia gravis

Objective:To study what measures may lower the mortality and morbidity of patients with myasthenia gravis (MG) crises in in patients with MG.Methods:One hundred and sixty seven MG patients were divided into two groups according to the time of admission.The mortality and morbidity of MG crises were contrasted before and after application of heterogeneous monitoring,selective tracheotomy in advance and improvement of general anaesthesia.Results:The morbidity and mortality of MG crises were far higher in the first group than those in the second group ( P <0 01),because of the lack of heterogeneous monitoring,selective tracheotomy in advance and improvement of general anaesthesia,while the morbidity and mortality of MG crises in perioperative period were lowered by these measures mentioned above in the second group.Conclusion:The heterogeneous monitoring was helpful in discovering the changes of vital index during operation and in the early stage after operation which might offer therapeutic basis for timely management.And it was helpful in lowering the morbidity and mortality of MG crises in the perioperative period during which tracheotomy in advance was simultaneously performed with thymectomy in more severe patients,respiratory support in the early stage after operation was given,small dose of non depolarising neuromuscular blocking agents was applied in the course of guiding anaesthesia.Ketamine was mainly used and inhalation of anaesthetics such as nitrous oxide (N 2O) and enflurane or isoflurane was administered at intervals during maintaining anaesthesia,and patients′automatic respiration was kept during operation.