Kowalczyk Michał, Nestorowicz Andrzej, Stachurska Katarzyna, Fijałkowska Anna, Stążka Janusz
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J Neurosci Nurs. 2015 Jun;47(3):161-5. doi: 10.1097/JNN.0000000000000138.
Nowadays, even hazardous cardiac surgery can be performed on patients with autoimmune diseases like myasthenia gravis. It requires a sensitive perioperative anesthetic approach especially in relation to nondepolarizing muscle relaxant administration. Myasthenic patients produce antibodies against the end-plate acetylcholine receptors causing muscle weakness and sensitivity to nondepolarizing muscle relaxants that could lead to respiratory failure. Perioperative nurse care is critical for uncomplicated course of treatment; therefore, apprehension of surgical procedure should be helpful on an everyday basis. We describe successful management without any pulmonary complications of two patients with myasthenia gravis undergoing coronary artery bypass grafting. In addition, antiacetylcholine receptor antibodies concentrations were evaluated during treatment time. In conclusion, we have found that reduced titrated doses of cisatracurium may be safely used in patients with myasthenia gravis undergoing cardiac surgery without anesthesia and respiratory-related complications.
如今，即使是患有重症肌无力等自身免疫性疾病的患者也可以接受危险的心脏手术。这需要一种敏感的围手术期麻醉方法，尤其是在使用非去极化肌肉松弛剂方面。重症肌无力患者会产生针对终板乙酰胆碱受体的抗体，导致肌肉无力以及对非去极化肌肉松弛剂敏感，这可能会导致呼吸衰竭。围手术期的护理对治疗过程顺利至关重要；因此，了解手术过程在日常工作中会有所帮助。我们描述了两名接受冠状动脉旁路移植术的重症肌无力患者成功的治疗管理，且无任何肺部并发症。此外，在治疗期间评估了抗乙酰胆碱受体抗体的浓度。总之，我们发现，在接受心脏手术的重症肌无力患者中，减少顺式阿曲库铵的滴定剂量可安全使用，且无麻醉和呼吸相关并发症。
