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目的 探讨围手术处理因素在治疗重症肌无力中的作用及其对手术后效果的影响。方法 回顾性分析 5 8例重症肌无力患者在临床分型、病理检查结果、围手术期抗胆碱酯酶药物剂量、辅助呼吸等方面对手术结果的影响。结果 手术后并发危象 9例 ,死亡 3例 ,辅助呼吸时间 (0～ 96 0h) ,平均 12 1h。气管切开 11例 ,纵隔感染 5例。术后随访的 4 9例中 ,症状完全缓解 4 0例 (81 6 % ) ,部分缓解 5 (10 2 % ) ,总缓解率 4 5 (91 8% )。结论 影响手术效果的主要原因是Os serman分型在Ⅱb 型以上 ,术前抗胆碱酯酶用药不规律 ,手术后有效的呼吸辅助类型的选择、呼吸道的管理及其肺部并发症防治 ,手术时机选择的恰当与否 ,有无合并胸腺肿瘤等因素。为防止术后出现猝发肌无力危象 ,可适时作气管切开 ,但掌握切开的时机仍有待进一步研究确定
Objective To investigate the role of perioperative management in the treatment of myasthenia gravis and its effect on postoperative outcome. Methods A retrospective analysis of 58 cases of myasthenia gravis in patients with clinical classification, pathological findings, perioperative anticholinesterase dose, assisted breathing and other aspects of the surgical results. Results There were 9 crisis cases after operation, 3 deaths, and assisted breathing time (0 ~ 96 0h) with an average of 121h. Tracheotomy in 11 cases, mediastinal infection in 5 cases. Among the 49 patients who were followed up, the symptoms were completely relieved 40 (81.6%), partial response 5 (102%), and the total response rate 45 (91.8%). Conclusion The main reason for the effect of surgery is that Os serman classification is more than type IIb, the irregular medication of anticholinesterase before surgery, the effective respiratory assistance type selection after surgery, the management of respiratory tract, the prevention and treatment of pulmonary complications, the operation The timing of the right choice or not, with or without thymoma and other factors. In order to prevent the occurrence of sudden muscle weakness crisis after surgery, tracheotomy can be timely, but to grasp the timing of incision still needs further study to determine