氨溴索在胸腔镜胸腺扩大切除术治疗重症肌无力围术期的应用  

Clinical Application of Ambroxol in Perioperative Period of Thoracoscopic Thymectomy for Myasthenia Gravis

作　　者：尹东涛[1] 韩冰[1] 褚剑[1] 梁涛[1] 陈秀[1] 王道喜[1] 刘娜[1] 

机构地区：[1]第二炮兵总医院心胸外科,北京100088

出　　处：《医学综述》2015年第14期2666-2668,共3页Medical Recapitulate

摘　　要：目的评价氨溴索在胸腔镜胸腺扩大切除术治疗重症肌无力围术期的应用价值。方法选择2011年8月至2013年2月第二炮兵总医院采取胸腔镜下胸腺扩大切除术治疗重症肌无力的患者48例,其中Osserman分型Ⅱa型及以上共36例,采用随机数字表法分为两组,各18例。观察组在围术期给予盐酸氨溴索注射液90 mg/d静脉滴注,对照组仅给予常规治疗。观察两组患者术后肺部并发症、"先兆危象"、危象发生率及术后住院时间。结果患者均顺利完成全胸腔镜下胸腺及胸腺瘤扩大切除术,无中转开胸手术及围术期死亡。术后病理胸腺瘤5例(13.9%),胸腺增生18例(50.0%),胸腺囊肿2例(5.6%),胸腺萎缩11例(30.5%)。术后发生"先兆危象"7例(19.4%),经积极治疗后,5例缓解,2例发生肌无力危象(5.6%)。肺部并发症4例(11.1%)。观察组术后住院时间少于对照组,差异有统计学意义(P<0.05)。结论重症肌无力胸腔镜下胸腺扩大切除术围术期应用氨溴索,对于防治术后危象有重要意义。Objective To estimate the effect of perioperative application of ambroxol in thoracoscopic thymectomy for myasthenia gravis.Methods A total of 48 cases of myasthenia gravis who underwent thora-coscopic thymectomy in the Second Artillery General Hospital of PLA from Aug.2011 to Feb.2013,including 36 cases with Osserman staging Ⅱa,Ⅱb,Ⅲ,and Ⅳ,which were divided into two groups according to ran-dom number table method,18 cases in each group.Ambroxol 90 mg/d was used in the observation group perioperatively and the control group received only conventional treatment.The postoperative pulmonary com-plications,hospitalization time,and incidence of ″threatened myasthenic crisis″and myasthenic crisis of the two groups were observed.Results All cases underwent thoracoscopic thymectomy successfully with no case converting to thoracotomy and no perioperative death .Postoperative pathology results showed that there were 5 cases（13.9%） of thymoma,18 cases（50.0%） of thymic hyperplasia,2 cases（5.6%） of thymic cyst and 11 cases（30.5%） of thymus atrophy.Totally 7 cases （19.4%） in 36 cases underwent ″threatened myas-thenic crisis″in which 2 cases （5.6%） developed myasthenic crisis and 5 cases （13.8%） relieved.4 cases （11.1%） underwent pulmonary complications.The postoperative hospitalization time was shorter significantly in the observation group than in the control group（P〈0.05）.Conclusion Application of ambroxol is safe and valuable in the thoracoscopic thymectomy for myasthenia gravis,which is of great significance for the pre-vention and treatment of perioperative myasthenic crisis .

关 键 词：重症肌无力 氨溴索 胸腺切除术 电视胸腔镜手术 围术期 

分 类 号：R736.3[医药卫生—肿瘤]