强肌健力法在胸腺扩大切除治疗重症肌无力中的应用研究  

Effect of Muscle-strengthening Therapy on Myasthenia Gravis Patients After Extended Thymectomy

作　　者：王继勇[1] 刘艳中[1] 郭亚雄[1] 杨明[1] 沈春辉[1] 吴志钰[1] 孙志佳[1] 汪真辉 

机构地区：[1]广州中医药大学第一附属医院胸心外科,广东广州510405

出　　处：《广州中医药大学学报》2016年第3期293-298,共6页Journal of Guangzhou University of Traditional Chinese Medicine

摘　　要：【目的】探讨术前应用强肌健力法是否可减少重症肌无力(MG)术后危象的发生,研究中性粒细胞与淋巴细胞的比值(NLR)与强肌健力法运用之间是否存在相关联系,以及该指标是否有预测MG术后疗效的价值。【方法】回顾分析广州中医药大学第一附属医院2011年11月至2015年1月符合条件的44例行胸腺扩大切除术的MG患者的临床资料,根据术前服药情况分为强肌健力组及常规治疗组,比较2组术后MG危象发生率及术前术后NLR变化情况。【结果】共入组44例患者,其中强肌健力组24例,常规治疗组20例。术后出现MG危象共3例,其中强肌健力组1例,常规治疗组2例,术后MG危象总发生率为6.82%,低于国内外同期水平。3例危象患者均通过呼吸机机械通气顺利康复出院。强肌健力组术后NLR水平明显高于常规治疗组(P<0.05)。【结论】强肌健力法可减少MG患者术后危象的发生率,但因本研究为回顾性研究,且样本量较少,其有效性仍需大样本的随机对照试验加以验证。Objective To evaluate the effect of the preoperative use of muscle-strengthening therapy on preventing postoperative crisis of myasthenia gravis（MG） and on neutrophil lymphocyte ratio（NLR）,and to explore the prognostic value of NLR for MG. Methods The detailed clinical data of 44 MG patients after extended thymectomy admitted from November of 2011 to January of 2015 were retrospectively reviewed. Patients were divided into observation group（24 cases） and control group（20 cases）. Both groups had extended thymectomy,and also the control group was given prednisolone orally and the observation group was treated with oral use of herbal medicine with the actions of strengthening spleen and muscle power. The clinical outcomes included postoperative myasthenic crisis incidence and NLR before and after operation. Results Postoperative myasthenic crisis occurred in 3 cases, and one was from the observation group and 2 were from the control group,with an overall incidence of 6.82%,which was lower than the oversea and domestic current level. The 3cases of postoperative myasthenic crisis recovered and then discharged from the hospital after invasive mechanical ventilation. The postoperative NLR of observation group was higher than the control group（P〈0.05）.Conclusion The results indicated that muscle-strengthening therapy can decrease the incidence of postoperative myasthenic crisis. However, for the sample size was small, its effectiveness should be further verified by randomized clinical trial with large sample size.

关 键 词：重症肌无力 胸腺扩大切除术 重症肌无力危象 强肌健力法 

分 类 号：R746.1[医药卫生—神经病学与精神病学]