Ando Takeshi, Omasa Mitsugu, Kondo Takayuki, Yamada Tetsu, Sato Masaaki, Menju Toshi, Aoyama Akihiro, Sato Toshihiko, Chen Fengshi, Sonobe Makoto, Date Hiroshi
Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
Eur J Cardiothorac Surg. 2015 Nov;48(5):705-9; discussion 709. doi: 10.1093/ejcts/ezu530. Epub 2015 Jan 24.
Postoperative myasthenic crisis (POMC) is one of the serious complications after extended thymectomy for patients with myasthenia gravis (MG). This study aims to clarify the risk factors of POMC occurrence.
The clinical data of 55 MG patients (25 male, 30 female; median age, 51 years) who underwent extended thymectomy at Kyoto University from 2000 to 2013 were retrospectively reviewed. Surgical outcomes and pre- and perioperative predictive factors of POMC were analysed.
The preoperative Myasthenia Gravis Foundation of America stage was I, II, III and IV in 24, 22, 8 and 1 patients, respectively. Ten patients (18.2%) developed POMC; 6 required prolonged intubation over 24 h and 4 required reventilatory support. All patients were weaned after 5.6 (2-26) days of ventilator support, and were discharged. Univariate analysis revealed a correlation with a high preoperative anti-acetylcholine receptor antibody titre (P = 0.009), history of myasthenic crisis (MC) (P = 0.0004) and unstable MG after preoperative medical therapy (P = 0.003). Multivariate logistic regression analysis showed history of MC (odds ratio, 11.84; 95% confidential interval, 1.05-372; P = 0.045) and unstable MG (odds ratio, 29.45; 95% confidential interval, 2.00-1063; P = 0.013) independently predicted POMC. The surgical response rate was not significantly different between the two groups (66.7% with POMC, 85.4% without POMC; P = 0.334).
POMC occurred more frequently in unstable MG before surgery or in patients with a history of MC. Adequate preoperative medical therapy and perioperative care should be provided to these patients.
术后肌无力危象（POMC）是重症肌无力（MG）患者扩大胸腺切除术后的严重并发症之一。本研究旨在阐明POMC发生的危险因素。
回顾性分析2000年至2013年在京都大学接受扩大胸腺切除术的55例MG患者（男25例，女30例；中位年龄51岁）的临床资料。分析手术结果以及POMC的术前和围手术期预测因素。
术前美国重症肌无力基金会分级为I级、II级、III级和IV级的患者分别有24例、22例、8例和1例。10例患者（18.2%）发生了POMC；6例需要超过24小时的长时间插管，4例需要再次通气支持。所有患者在呼吸机支持5.6（2 - 26）天后脱机并出院。单因素分析显示，术前抗乙酰胆碱受体抗体滴度高（P = 0.009）、肌无力危象（MC）病史（P = 0.0004）以及术前药物治疗后MG病情不稳定（P = 0.003）与之相关。多因素逻辑回归分析显示，MC病史（比值比，11.84；95%置信区间，1.05 - 372；P = 0.045）和MG病情不稳定（比值比，29.45；95%置信区间，2.00 - 1063；P = 0.013）独立预测POMC。两组的手术缓解率无显著差异（发生POMC组为66.7%，未发生POMC组为85.4%；P = 0.334）。
POMC在术前MG病情不稳定或有MC病史的患者中更频繁发生。应给予这些患者充分的术前药物治疗和围手术期护理。
