全身型重症肌无力患者术后危象的相关因素分析  

Prognostic factors of myasthenic crisis after extended thymectomy in patients with generalized myasthenia gravis

作　　者：刘卫彬 门丽娜[1] 唐白云 黄如训 

机构地区：[1]深圳市儿童医院神经科

出　　处：《中华医学杂志》2006年第39期2737-2740,共4页National Medical Journal of China

基　　金：广东省科委重点项目资助(102016;133017)

摘　　要：目的探讨全身型重症肌无力(MG)患者胸腺扩大切除术后危象的影响因素。方法对176例全身型 MG 患者术后危象的影响因素采用病例-对照研究的方法。36例发生术后危象。研究项目包括:性别、手术时年龄、手术时病程、胸腺病理类型、手术时受累部位、手术时临床分型(Osserman 分型)、术前感染史(术前1个月内)、术前危象史(术前1个月内)、术前吡啶斯的明用量(mg/d)、术前激素使用情况、手术持续时间(min)、手术过程的出血量(ml)、手术时胸膜破损情况。结果单因素分析显示:术前吞咽肌受累(OR=8.494,P=0.001),术前危象史(OR=5.667,P=0.000),胸腺瘤(OR=2.147,P=0.047),Ⅲ、Ⅳ型(OR=4.549,P=0.000),术前感染史(OR=3.30,P=0.038),术前吡啶斯的明用量大(OR=1.019,P=0.001),手术持续时间长(OR=1.012,P=0.034),出血量多(OR=1.004,P=0.012)为术后发生危象的危险因素,进行 Logistic 回归模型多因素分析显示:术前吞咽肌受累(OR=7.709,P=0.003)、术前感染史(OR=4.582,P=0.037)、术前危象史(OR=4.526,P=0.001)、术前吡啶斯的明用量大(OR=1.016,P=0.01)是术后发生危象的独立影响因素。结论术前吞咽肌受累、术前感染史、术前危象史、术前吡啶斯的明用量大是术后发生危象的独立影响因素。术前做好充分准备,尽可能降低术后危象的发生。Objective To investigate the prognostic factors of myasthenic crisis after extended thymectomy in patients with generalized myasthenia gravis （MG）. Methods Extended thymectomy was performed on 176 patients with generalized MG, 74 males and 102 females, aged 4-67, of which 36 experienced postoperative myasthenic crisis and required prolonged mechanical ventilation. The relations among the age, sex, preoperative course of disease, pathologic type of thymus, Osseman classification, history of infection during 1 month preoperatively, history of myasthenic crisis 1 month preoperatively, thyoma, preoperative daily dose of pyridostigmine, preoperative steroid use, operation time, intra-operative blood loss, and intra-operative pleura injury and postoperative myasthenia crisis were analyzed. Results Univariate analysis showed that bulbar symptoms （ OR = 8.494, P = 0. 001 ）, history of myasthenic crisis 1 month preoperatively （ OR = 5. 667, P = 0. 000）, thyoma （ OR = 2. 147, P = 0. 047） , Osserman types Ⅲ and Ⅳ （ OR = 0. 459, P = 0. 000 ）, history of infection during 1 month preoperatively （ OR = 3.30, P = 0. 038）, large pre-operative dose of pyridostigmine （ OR = 1. 019, P =0. 001 ） , long operation time （ OR = 1.012, P =0.034）, and more blood loss （186 ml±163 ml） （OR = 1.004, P =0.012）, were all prognostic factors or postoperative myasthenic crisis. However, multivariate logistic regression analysis revealed that preoperative bulbar symptoms （ OR = 7.709, P = 0. 003 ）, history of infection during 1 month preoperatively （ OR = 4. 582, P = 0. 037 ）, history of myasthenic crisis 1 month preoperatively （ OR = 4. 526, P = 0. 001, large pre-operative dose of pyridostigmine （ OR = 1. 016, P = 0. 001 ） were prognostic factors of postoperative myasthenic crisis. Conclusion Preoperative bulbar symptoms, history of preoperative myasthenic crisis, history of preoperative infection, and large preoperative dose of, pyridostigmine are all independent influencing factors of pos

关 键 词：重症肌无力 胸腺切除术 手术后危象 

分 类 号：R746.1[医药卫生—神经病学与精神病学]