重症肌无力患者胸腺切除术后危象发生的多因素分析  

Factors Contributing to Myasthenic Crisis after Thymectomy—A Multivariate Analysis Study

作　　者：陈佶[1] 庞烈文[1] 陈志明[1] 马勤运[1] 陈刚[1] 黄杰春[1] 郝振华[1] 朱勇俊[1] 

机构地区：[1]复旦大学附属华山医院胸外科,200040

出　　处：《中国临床神经科学》2007年第2期169-173,共5页Chinese Journal of Clinical Neurosciences

摘　　要：目的:探讨重症肌无力(MG)患者胸腺切除术后危象发生的影响因素。方法:回顾性分析2002年7月至2005年12月确诊为MG患者进行胸腺切除术101例患者的资料。对性别、年龄、术前危象史、Ossermen分型、激素使用时间和剂量、非口服止痛药、术前心电图、血红蛋白、白蛋白、肌力、伴随免疫疾病;手术及麻醉时间、切口方式、切除范围、胸腺瘤、病理类型、输血和病程;术后最高体温、肺部感染、术后第2天白细胞数、中性粒细胞百分比、乙酰胆碱受体抗体(AChRab)、突触前膜受体抗体(PrsmRab)、连接素抗体(Titinab)进行多因素Logistic回归分析。结果:术后出现MG危象29(28.7%)例。危象的发生与伴随免疫疾病、Ossermen分型、术后肺部感染、术前危象史和年龄因素有关。结论:伴随免疫疾病、OssermenⅡb型及以上、术后肺部感染、术前有危象史和大龄患者均易发生术后危象。Aim： To identify the clinical features of the patients with myasthenia gravis（MG） indicative of myasthenic crisis（MC） after thymectomy. Methods： A retrospective study was conducted in 101 thymectomized patients with MG from July 2002 to December 2005. The following factors were evaluated ： sex, age, history of preoperative crisis, Ossermen classification, duration and dose of steroids, nonoral analgesics, pathology, EKG, operation time, anaesthesia time, body temperature, WBC, percentage of neutrophils, hemoglobin, albumin, muscle strength, concomitant autoimmune diseases, postoperative lung infection, AChRab, PrsmRab, Titinab, incision, resection status of thymus, presence of thymoma, transfusion, course of disease, etc. Multivariate logistic regression analysis was used to find the predictors of postoperative myasthenic crisis. Results： Twenty-nine patients（28.7% of all 101 patients） developed myasthenic crisis after thymectomy. Statistics showed that concomitant autoimmune diseases, Ossermen classification, postoperative lung infection, history of crisis and age were related to postoperative myasthenic crisis. Conclusion ： Concomitant autoimmune diseases, Ossermen classification ≥ Ⅱ b, postoperative lung infection, history of crisis and higher age are the independent risk factors for myasthenic crisis after thymectomy. Meticulous perioperative care should be carried out in high risk patients.

关 键 词：重症肌无力 胸腺切除 危象 多因素分析 

分 类 号：R746.1[医药卫生—神经病学与精神病学] R736.3[医药卫生—临床医学]