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目的分析重症肌无力(MG)患者胸腺扩大切除术后发生肌无力危象(PTMC)的原因及影响呼吸机使用时间的因素。方法回顾性分析大坪医院2008年6月至2014年11月确诊为MG并在胸腺扩大切除术后发生危象79例患者的临床资料,其中男38例、女41例,进行单因素与多因素分析。结果全组PTMC发生率为20.6%(79/384)。单因素分析结果显示,术后肺部感染是影响呼吸机使用时间的重要原因,差异有统计学意义(P<0.05),与性别、Osserman分型、术前危象史无相关性(P>0.05)。多因素分析结果显示,呼吸机使用时间与手术时间呈正相关(P<0.05),与年龄、病程、术前及术后溴吡斯的明用量、手术径路及出血量不相关(P>0.05)。结论 PTMC治疗主要依赖于呼吸机辅助呼吸、手术时间及肺部感染是影响PTMC患者呼吸机辅助呼吸时间的主要因素。MG患者应尽可能短缩手术时间,术后需采取有效措施避免肺部感染,从而降低PTMC的发生并缩短呼吸机使用时间。
Objective To analyze the causes of myasthenic crisis (PTMC) after thymus enlargement resection in patients with myasthenia gravis (MG) and the factors influencing the duration of ventilator. Methods The clinical data of 79 patients diagnosed as MG with crisis after thymus enlargement resection from June 2008 to November 2014 in Daping Hospital were retrospectively analyzed. There were 38 males and 41 females, and single and multiple factors analysis. Results The incidence of PTMC in the whole group was 20.6% (79/384). The results of univariate analysis showed that postoperative pulmonary infection was an important reason affecting the use time of ventilator, the difference was statistically significant (P <0.05), but no correlation with gender, Osserman classification and preoperative crisis (P> 0.05). Multivariate analysis showed that ventilator use time was positively correlated with operative time (P <0.05), but not related to age, course of disease, preoperative and postoperative bromopyrazine exposure, surgical approach and blood loss (P> 0.05) . Conclusion PTMC treatment mainly relies on ventilator assisted breathing, operation time and pulmonary infection are the main factors affecting ventilator assisted breathing time in patients with PTMC. MG patients should shorten the operation time as possible, after taking effective measures to avoid lung infection, thereby reducing the incidence of PTMC and shorten the use of ventilator time.