Ferretti F, Crestani S, Rodriguez N J, Tosi C, Martinoli S
Schweiz Med Wochenschr. 1987 Mar 21;117(12):438-41.
Analgesia is an important problem in myasthenia gravis patients who have undergone transsternal thymectomy. Postoperative pain interferes with pulmonary function, which is already limited by the disease. The choice of medication is restricted because many analgesics are synergic to the myasthenia gravis syndrome and detrimental to the patient. Three patients with severe myasthenia gravis are presented who had undergone transsternal thymectomy with good postoperative results. They received high thoracal epidural anesthesia (C7-Th1/Th1-Th2/Th2-Th3) with a solution of bupivacaine and morphine (20 ml 0.25% bupivacaine with 10% morphine). The patients were extubated in the first 48 hours and monitoring of respiratory function (CV2, PO2, PCO2) showed satisfactory values. With this type of analgesia we obtained early mobilization and good patient cooperation. Although limited this favourable experience confirms that high thoracal epidural anesthesia is a sure technique which allows rapid weaning from the ventilator and maximum comfort for the patient. It avoids the use of other medication or analgesics which are contraindicated in these patients.
对于接受过经胸骨胸腺切除术的重症肌无力患者而言，镇痛是一个重要问题。术后疼痛会干扰肺功能，而肺功能本身就已因该疾病而受限。药物选择受到限制，因为许多镇痛药会与重症肌无力综合征产生协同作用，对患者有害。本文介绍了3例接受经胸骨胸腺切除术且术后效果良好的重症肌无力患者。他们接受了高位胸段硬膜外麻醉（C7 - Th1/Th1 - Th2/Th2 - Th3），使用布比卡因和吗啡溶液（20毫升0.25%布比卡因加10%吗啡）。患者在术后48小时内拔管，呼吸功能监测（CV2、PO2、PCO2）显示数值令人满意。通过这种类型的镇痛，我们实现了患者的早期活动及良好的配合。尽管经验有限，但这一良好经验证实，高位胸段硬膜外麻醉是一种可靠的技术，可使患者快速脱离呼吸机，并使其获得最大程度的舒适。它避免了使用这些患者禁忌的其他药物或镇痛药。
