胸腺切除术后肌无力危象机械通气影响因素分析  

Risk Factors for Prolonged Mechanical Ventilation in Post-thymectomy Myasthenic Crisis

作　　者：李昆昆[1] 谭群友[1] 郭伟[1] 马铮[1] 王如文[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所胸外科,重庆400042

出　　处：《中国胸心血管外科临床杂志》2015年第5期463-466,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：军队临床高新技术重大项目(2010gxjs073);第三军医大学临床科研重点项目(2007XG062)~~

摘　　要：目的分析重症肌无力(MG)患者胸腺扩大切除术后发生肌无力危象(PTMC)的原因及影响呼吸机使用时间的因素。方法回顾性分析大坪医院2008年6月至2014年11月确诊为MG并在胸腺扩大切除术后发生危象79例患者的临床资料,其中男38例、女41例,进行单因素与多因素分析。结果全组PTMC发生率为20.6%(79/384)。单因素分析结果显示,术后肺部感染是影响呼吸机使用时间的重要原因,差异有统计学意义(P<0.05),与性别、Osserman分型、术前危象史无相关性(P>0.05)。多因素分析结果显示,呼吸机使用时间与手术时间呈正相关(P<0.05),与年龄、病程、术前及术后溴吡斯的明用量、手术径路及出血量不相关(P>0.05)。结论 PTMC治疗主要依赖于呼吸机辅助呼吸、手术时间及肺部感染是影响PTMC患者呼吸机辅助呼吸时间的主要因素。MG患者应尽可能短缩手术时间,术后需采取有效措施避免肺部感染,从而降低PTMC的发生并缩短呼吸机使用时间。Objective To analyze the risk factors for post-thymectomy myasthenic crisis （PTMC） and prolonged mechanical ventilation, in myasthenia gravis patients who underwent extended thymectomy. Methods We retrospectively analyzed the clinical data of 79 patients including 38 males and 41 females who experienced PTMC and required mechanical ventilation in Daping Hospital between June 2008 and November 2014. Single factor analysis and multivariate analysis were conducted. Results Morbidity of PTMC was 20.6% （79/384）. Result of single-factor analysis showed that postoperative pneumonia was one of the main reasons of prolonged mechanical ventilation （P〈0.05）. Result of multiple-factor analysis showed that the operation time was positively correlated with mechanical ventilation time （P〈0.05）. The risk factor of prolonged mechanical ventilation time in PTMC was not associated with sex, age, disease history, myasthenic crisis history, Osserman classification, dosage of pyridostigmine before and after the operation, surgical approach, bleeding volume, other therapies besides mechanical ventilation （P〉0.05）. Conclusion Mechanical ventilation is one the main therapy of PTMC, operation time, and postoperative pneumonia are the main factors to prolong mechanical ventilation time. In order to decrease morbidity of PTMC and shorten mechanical ventilation time,the operation time should be controlled and pulmonary infection should be avoided.

关 键 词：重症肌无力 胸腺扩大切除 肌无力危象 肺部感染 机械通气 

分 类 号：R746.1[医药卫生—神经病学与精神病学]