Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
J Surg Res. 2021 Jun;262:1-5. doi: 10.1016/j.jss.2020.12.048. Epub 2021 Jan 30.
The objective of this study is to characterize postoperative myasthenic crisis (POMC), after extended thymectomy and discuss the treatment options for this condition.
Clinical data from patients with generalized myasthenia gravis (MG) who underwent extended thymectomy at Xuanwu Hospital of the Capital Medical University from 2016 to 2018 were reviewed retrospectively. Patients were divided into two groups-POMC and non-POMC. Variables that could potentially predict POMC were analyzed. In the POMC group, the aforementioned variables were compared between patients with and without pneumonia.
Ninety-seven patients were enrolled. Thirty-eight (39.2%) patients developed POMC. The mean duration of mechanical ventilation (MV), length of intensive care unit stay, and duration of hospital stay were significantly longer in the POMC group (P < 0.001). Multivariate logistic regression analysis showed that disease severity, symptom duration longer than 12 mo, and transsternal thymectomy were independent risk factors for POMC. Postoperative pneumonia significantly prolonged the MV period (P = 0.012) and weaning from MV after intravenous immunoglobin (IVIg) treatment (P = 0.005) in POMC patients. Twenty-four (24.7%) POMC patients who received IVIg were successfully weaned from MV and were discharged.
Disease severity, symptom duration longer than 12 mo, and transsternal thymectomy were independent risk factors for POMC. Postoperative pneumonia worsens the prognosis of POMC.
本研究旨在描述扩大胸腺切除术（extended thymectomy）后术后肌无力危象（postoperative myasthenic crisis，POMC）的特征，并探讨这种情况的治疗选择。
回顾性分析 2016 年至 2018 年首都医科大学宣武医院行扩大胸腺切除术的全身型重症肌无力（generalized myasthenia gravis，MG）患者的临床资料。患者分为 POMC 组和非 POMC 组。分析可能预测 POMC 的变量。在 POMC 组中，比较了伴有和不伴有肺炎的患者的上述变量。
共纳入 97 例患者，38 例（39.2%）患者发生 POMC。POMC 组机械通气（mechanical ventilation，MV）时间、重症监护病房（intensive care unit，ICU）住院时间和住院时间均明显延长（P < 0.001）。多因素 logistic 回归分析显示，疾病严重程度、症状持续时间>12 个月和经胸骨胸腺切除术是 POMC 的独立危险因素。术后肺炎显著延长了 POMC 患者的 MV 时间（P = 0.012）和静脉注射免疫球蛋白（intravenous immunoglobin，IVIg）治疗后脱机时间（P = 0.005）。24 例（24.7%）接受 IVIg 治疗的 POMC 患者成功脱机并出院。
疾病严重程度、症状持续时间>12 个月和经胸骨胸腺切除术是 POMC 的独立危险因素。术后肺炎使 POMC 的预后恶化。
