重症肌无力患者基于临床分型的围术期准备  

Preoperative preparation for myasthenia gravis patients based on the MGFA classification

作　　者：秦雪梅[1] 鲁卫华[1] 金孝岠[1] 姜小敢[1] 吴敬医[1] 王箴[1] 

机构地区：[1]皖南医学院弋矶山医院麻醉与重症医学科,安徽省芜湖市241001

出　　处：《实用医学杂志》2015年第1期61-63,共3页The Journal of Practical Medicine

基　　金：安徽省卫生厅医学科研项目(编号:2010C066)

摘　　要：目的:探讨不同临床分型的重症肌无力(MG)患者的围术期准备方法,以减少围术期肌无力危象及相关并发症的发生。方法:回顾性分析62例我院确诊为MG患者行胸骨正中切口胸腺切除手术的临床资料,根据不同MGFA分型分为A组(I型)和B组(Ⅱa型及其以上),比较两组患者术前使用吡啶斯的明和强的松的治疗剂量、围术期用药方案及术后呼吸功能的恢复情况。结果:45例患者在术毕2 h内成功拔管,拔管率为72.58%;17例术后呼吸恢复不佳需呼吸支持,其中2例发生肺部感染,4例发生肌无力危象,术后呼吸支持率为27.42%。B组术后呼吸支持率高于A组(P<0.05);B组吡啶斯的明和激素的剂量均高于A组(P<0.05);呼吸支持组激素用量高于非呼吸支持组,联合激素组术后呼吸支持率高于单用吡啶斯的明组(P<0.05)。结论:MG患者术后呼吸支持率与MGFA分型有关,围手术期应根据不同临床分型,合理使用胆碱酯酶抑制剂和肾上腺皮质激素,尽可能用最小的药物剂量将临床分型降低。Objective To explore the perioperative preparation for myasthenia gravis （MG） patients undergoing thymectomy based on the MGFA classification to reduce the incidence of perioperative myasthenic crisis and related complications. Methods A retrospective analysis was conducted in 62 patients with MG, which were divided into two groups： Group A （MGFA class： Ⅰ） and Group B （MGFA class： Ⅱ a-V ）. The adminstration of pyridostigmine and hormone in these two groups were analyzed. The respiratory recovery process was also studied. Results Forty-five of the 62 patients were successfully extubated after thymectomy, with the extubation rate of 72.58%. Seventeen of the 62 patients required respiratory support over 2 h after thymectomy or one more endotracheal intubation after extubation, including 2 cases with pulmonary infection and 4 cases with myasthenia gravis crisis, with the delayed extubation rate of 27.42%. The rate of prolonged mechanical ventilation in Group B was significantly higher than that in Group A （P 〈 0.05）. The dosages of pyridostigmine and hormone in Group B were significantly higher than those in Group A （P 〈 0.05）. The dosage of hormone was higher in those patients received respiratory support. MG patients received combination hormone therapy were significantly higher than the patients received pyridostigmine alone based on the rate of prolonged mechanical ventilation （P 〈 0.05）. Conclusion Rational uses of cholinesterase inhibitors and corticosteroids according to the MGFA classification can lead to a lower incidence of prolonged mechanical ventilation in patients with MG.

关 键 词：重症肌无力 MGFA分型 胆碱酯酶抑制剂 肾上腺皮质激素 呼吸支持 

分 类 号：R746.1[医药卫生—神经病学与精神病学]