儿童重症肌无力患者胸腺切除术后肌无力危象的影响因素  

Factors Affecting Myasthenia Gravis Crisis after Thymectomy in Children with Myasthenia Gravis

作　　者：张思思 王军[1] 张昆[1] ZHANG Si-si;WANG Jun;ZHANG Kun(Hanzhong Central Hospital,Hanzhong Shaanxi 723000)

机构地区：[1]汉中市中心医院儿科,陕西汉中723000

出　　处：《医学临床研究》2023年第4期508-510,514,共4页Journal of Clinical Research

摘　　要：【目的】探讨儿童重症肌无力(MG)患者胸腺切除术后肌无力危象(POMC)的影响因素。【方法】本院收治的78例MG并行胸腺切除术的患儿,其中28例患儿出现POMC(POMC组),另50例未出现POMC(无POMC组),分析MG患儿胸腺切除术后POMC的影响因素。【结果】单因素分析显示,POMC组、无POMC组MG病程分别为(34.0±4.8)个月和(11.0±1.4)个月,两组比较差异有统计学意义(P<0.05);POMC组改良Osserman分型Ⅱa、Ⅱb、Ⅲ及Ⅳ型分别为2例(7.1%)、21例(75.0%)、4例(14.3%)及1例(3.6%),无POMC组分别为15例(30.0%)、32例(64.0%)、3例(6.0%),无Ⅳ型,两组比较差异有统计学意义(P<0.05);POMC组行电视胸腔镜手术、传统开放手术分别为18例(64.3%)和10例(35.7%),与无POMC组的45例(90.0%)和5例(10.0%)比较,差异有统计学意义(P<0.05);POMC组和无POMC组术后发生肺炎者分别为13例(46.4%)和0例,两组比较差异有统计学意义(P<0.05)。将单因素分析有统计学意义的因素作为自变量,将MG患儿出现POMC作为因变量,纳入Logistic回归分析,结果提示,MG病程、术后肺炎是MG患儿出现POMC的独立危险因素(P<0.05),而手术方式(电视胸腔镜手术)则是保护性因素(P<0.05)。【结论】儿童MG患者胸腺切除术后POMC发生与术前MG病程、术后肺炎密切相关,相较于传统开放手术,电视胸腔镜手术能够显著避免POMC发生,值得临床推广。【Objective】To explore the influencing factors of myasthenia gravis crisis(POMC)after thymectomy in children with myasthenia gravis(MG).【Methods】A total of 78 children with MG who underwent thymectomy were admitted to our hospital,of which 28 had POMC(POMC group)and 50 did not(the non POMC group).The influencing factors of POMC after thymectomy in MG patients were analyzed.【Results】Univariate analysis showed that the duration of MG in the POMC group and the non POMC group was(34.0±4.8)months and(11.0±1.4)months,respectively,with a statistically significant difference between the two groups(P<0.05);In the POMC group,there were 2 cases(7.1%),21 cases(75.0%),4 cases(14.3%),and 1 case(3.6%)of modified Osserman classificationⅡa,Ⅱb,Ⅲ,andⅣ,respectively.In the non POMC group,there were 15 cases(30.0%),32 cases(64.0%),3 cases(6.0%),and 0 cases,respectively,with statistically significant differences(P<0.05);In the POMC group,18 cases(64.3%)underwent video-assisted thoracoscopic surgery and 10 cases(35.7%)underwent traditional open surgery,respectively.There was a statistically significant difference compared to 45 cases(90.0%)and 5 cases(10.0%)in the non POMC group(P<0.05);There were 13 cases(46.4%)and 0 cases of postoperative pneumonia in the POMC group and the non POMC group,respectively,with a statistically significant difference between the two groups(P<0.05).The statistically significant factors in univariate analysis were used as independent variables,and the occurrence of POMC in MG patients was included as the dependent variable in logistic regression analysis.The results suggest that the course of MG and postoperative pneumonia are independent risk factors for POMC in MG patients(P<0.05),while the surgical method(video-assisted thoracoscopic surgery)is a protective factor(P<0.05).【Conclusion】The occurrence of POMC in pediatric MG patients after thymectomy is closely related to the course of preoperative MG and postoperative pneumonia;Compared to traditional open surgery,video-assisted thor

关 键 词：重症肌无力/外科学 胸腺切除术 危险因素 

分 类 号：R746.1[医药卫生—神经病学与精神病学]