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目的 探讨重症肌无力 (MG)病人胸腺切除术围手术期行气管切开的适应症和相关危险因素。方法 回顾性分析我院自 1980年 4月至 1999年 8月因MG行胸腺切除术病人 174例 ,44例于围手术期行气管切开 ,占总数 2 5 .3 % ,3 8例发生危象 ,占总数 2 1.8%。分析了重症肌无力临床分型、病期、是否伴有胸腺瘤、术前肺功能情况和术前抗胆碱能药物用量等因素与肌无力危象之间的关系及需要行气管切开术的手术适应症。结果 MG病人病程长、服用抗胆碱能药物剂量大、临床分期为Ⅱb型以上、术前有肺功能损害及合并有胸腺瘤者 ,特别是伴有侵润型胸腺瘤的患者 ,术后发生危象较高 ,需气管切开的比例也相应较高。结论 重症肌无力病人胸腺切除术后发生危象 ,及时气管切开 ,人工呼吸器辅助呼吸是降低病死率的重要措施 ;术后立即预防性气管切开术应根据患者的病情严格掌握 ,不能滥用 ,以有利于病人恢复。
Objective To investigate the perioperative tracheotomy indications and related risk factors for thymectomy in patients with myasthenia gravis (MG). Methods A retrospective analysis of our hospital from April 1980 to August 1999 due to MG thymus resection of 174 patients, 44 patients underwent perioperative tracheotomy, accounting for a total of 25.3%, 38 cases of risk Like, accounting for 2 1.8% of the total. Analyzed the clinical classification of myasthenia gravis, duration of disease, whether associated with thymoma, preoperative pulmonary function and preoperative anticholinergic drugs dosage and other factors and the relationship between myasthenic crisis and the need for tracheotomy Indications for surgery. Results MG patients with longer duration, taking a large dose of anticholinergic drugs, clinical stage Ⅱ b above, preoperative pulmonary dysfunction and thymoma, especially those patients with invasive thymoma occurred after surgery Crisis is higher, the ratio of tracheostomy also correspondingly higher. Conclusions The risk of thymectomy in patients with myasthenia gravis, tracheotomy in time, and assisted respiration of artificial respirators are important measures to reduce the mortality. Prophylactic tracheotomy should be strictly controlled according to the patient’s condition and can not be abused , In order to facilitate the recovery of patients.