重症肌无力患者经胸骨正中切口胸腺切除术后肌无力危象的预后因素
Prognostic factors for myasthenic crisis after transsternal thymectomy in patients with myasthenia gravis.
作者信息
Watanabe Atsushi, Watanabe Toshiaki, Obama Takuro, Mawatari Tohru, Ohsawa Hisayoshi, Ichimiya Yasunori, Takahashi Noriyuki, Kusajima Katsuyuki, Abe Tomio
机构信息
Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo 060-8543, Japan.
出版信息
J Thorac Cardiovasc Surg. 2004 Mar;127(3):868-76. doi: 10.1016/j.jtcvs.2003.07.036.
OBJECTIVE
The purpose of this study was to assess which clinical features of patients with myasthenia gravis predict postoperative respiratory problems due to myasthenic crisis after transsternal thymectomy.
METHODS
One hundred twenty-two patients who underwent transsternal thymectomy in our institute were analyzed retrospectively. Fourteen of those experienced myasthenic crisis and required prolonged (48 hours or more) postoperative mechanical ventilation. The following factors were evaluated: sex, age, body mass index, grade of symptom, disease interval, existence of thymoma, history of preoperative crisis, doses of anticholinesterase drugs, steroid use, pulmonary function, serum anti-acetylcholine receptor antibody, history of pulmonary disease, presence of other disease, operation time, and blood loss.
RESULTS
Univariate analysis revealed preoperative bulbar symptoms (odds ratio = 14.246, P =.001), history of preoperative myasthenic crisis (7.091,.018), and preoperative serum level of anti-acetylcholine receptor antibody > 100 nmol/L (4.098,.044) were prognostic factors for postoperative myasthenic crisis. On the other hand, multivariate logistic regression analysis revealed preoperative bulbar symptoms (33.333,.004), preoperative serum level of anti-acetylcholine receptor antibody > 100 nmol/L (7.874,.020), and intraoperative blood loss > 1000 mL (18.519,.048) were prognostic factors for postoperative myasthenic crisis.
CONCLUSIONS
In this study, postoperative myasthenic crisis after transsternal thymectomy in 122 patients with myasthenia gravis was affected by the existence of preoperative bulbar symptoms, history of preoperative myasthenic crisis, preoperative serum level of anti-acetylcholine receptor antibody > 100 nmol/L, and intraoperative blood loss > 1000 mL. Meticulous preoperative and postoperative care should be carried out to prevent postoperative myasthenic crisis in patients with these prognostic factors.
目的
本研究旨在评估重症肌无力患者的哪些临床特征可预测经胸骨胸腺切除术后因肌无力危象导致的术后呼吸问题。
方法
对我院122例行经胸骨胸腺切除术的患者进行回顾性分析。其中14例发生肌无力危象，术后需要长时间（48小时或更长时间）机械通气。评估以下因素：性别、年龄、体重指数、症状分级、病程、胸腺瘤的存在、术前危象史、抗胆碱酯酶药物剂量、类固醇使用情况、肺功能、血清抗乙酰胆碱受体抗体、肺部疾病史、其他疾病的存在、手术时间和失血量。
结果
单因素分析显示术前球部症状（比值比=14.246，P=0.001）、术前肌无力危象史（7.091，0.018）和术前血清抗乙酰胆碱受体抗体水平>100 nmol/L（4.098，0.044）是术后肌无力危象的预后因素。另一方面，多因素逻辑回归分析显示术前球部症状（33.333，0.004）、术前血清抗乙酰胆碱受体抗体水平>100 nmol/L（7.874，0.020）和术中失血量>1000 mL（18.519，0.048）是术后肌无力危象的预后因素。
结论
在本研究中，122例重症肌无力患者经胸骨胸腺切除术后的肌无力危象受术前球部症状的存在、术前肌无力危象史、术前血清抗乙酰胆碱受体抗体水平>100 nmol/L和术中失血量>1000 mL的影响。对于有这些预后因素的患者，应进行细致的术前和术后护理，以预防术后肌无力危象。
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