重症肌无力患者胸腺切除手术前后呼吸肌功能变化  

Analysis of respiratory muscle strength and endurance changes in myasthenia gravis patients before and after thymetomy

作　　者：周怡[1] 赵卫国[1] 保鹏涛[1] 陈兵[1] 

机构地区：[1]解放军第309医院呼吸科,重症肌无力治疗中心,北京100091

出　　处：《中国神经精神疾病杂志》2011年第11期679-682,共4页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的分析重症肌无力(myasthenia gravis,MG)患者呼吸肌肌力变化情况,观察胸腺切除手术后患者呼吸肌肌力改善情况。方法分别检测健康成年人、Ⅰ型MG患者和Ⅱ型MG患者最大吸气压(maximalinspiratory pressure,MIP)、最大呼气压(maximal expiratory pressure,MEP),0.1 s口腔闭合压(mouth occlusion pres-sure at 0.1 s after onset of inspiratory effort,P0.1)、残气量(residual volume,RV)、最大通气量(maximal ventilatoryvolume,MVV)等肺功能指标。监测MG患者手术后呼吸肌肌力改善情况。结果与健康成年人相比,Ⅰ型和Ⅱ型MG患者的MIP、MVV均降低(Ⅰ型MG分别是70.86%±12.56%,79.60%±19.63%,Ⅱ型MG分别是46.40%±19.20%,66.10%±15.82%),RV升高(分别是212.60%±34.06%,143.56%±41.98%),另外Ⅱ型MG患者MEP也明显降低(24.42%±13.79%),(P<0.05)。60%(15/25)Ⅰ型MG患者出现MIP降低,64%(16/25)Ⅰ型MG患者低频重复神经电刺激检查(repetitive nerve stimulation,RNS)为阳性,两者相比无统计学意义(Ⅹ2=1.852,P>0.05)。术后1年内MG患者MIP、MEP、MVV、RV及呼吸肌耐力等肺功能指标较术前明显改善(分别由治疗前的41.52%±16.88%、25.05%±15.48%、66.52%±11.24%、185.12%±51.97%到54.13%±19.12%、34.12%±10.30%、77.58%±12.17%、138.25%±68.21%,P<0.05)。结论Ⅰ型、Ⅱ型MG患者存在呼吸肌肌力减退。最大呼吸压的测定和低频重复神经电刺激检查在评估I型MG患者减退的呼吸肌力有同样意义。而手术切除病变的胸腺组织能有效地改善MG患者呼吸功能。Objective To analyse respiratory muscle strength changes in patients with myasthenia gravis （MG）. Observed the improvement of respiratory muscle strength and endurance in MG patients after thymetomy. Methods Pul- monary function such as MIP, MEP, P0.1, RV and MVV were tested in health adults, MG patients in stage I and Ⅱ. Results MVV and MIP decreased in MG patients with stage I and Ⅱ （decreased respectively 70.86 ± 12.56%,79.60 ± 19.63% in I stage MG and 46.40% ± 19.20%, 66.10% ± 15.82% in Ⅱ stage MG）, whereas RV increased （212.60% ± 34.06%, 143.56% ± 41.98%）markedly compared with health adults, additionally MEP（24.42% .± 13.79%） also decreased in MG patients with Stage Ⅱ （P 〈 0.01）. MIP of 60% （15/25） I-type MG patients decreased, low frequency repetitive nerve stimulation（RNS）examination in 64% （16/25） I-type in patients MG were positive, there were no sig- nificant difference between them （X2 = 1.852, P 〉 0.05）. MIP, MEP, MVV, VC, RV and respiratory muscle endurance of MG patients significantly improved in a year of thymetomy （the 41.52%± 16.88%, 25.05% ± 15.48%, 66.52% ± 11.24%, 185.12% ± 51.97% improved to 54.13% ± 19.12%, 34.12% ± 10.30%, 77.58% ± 12.17%, 138.25% ± 68.21% respectively after thymetomy, P 〈 0.01 ）. Changes of Respiratory muscle endurance was no significant difference in thymoma or thymus hyperplasia patients （t = 3.521, P 〉 0.05）. Conclusion Respiratory muscle was involvement in stage I and Ⅱ MG patients. As RNS examination, MIP ang MEP was also helpful in the evaluation of the case of Ⅱ MG patients. Thymetomy can improve lung function in MG patients.

关 键 词：重症肌无力 呼吸肌肌力 呼吸肌耐受力 胸腺切除术 

分 类 号：R746.1[医药卫生—神经病学与精神病学]