Chen Ping, Bao Feichao, Pompeo Eugenio, Zhang Xuefei, Xu Tingting
Nursing Department, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Thoracic Surgery Department, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Gland Surg. 2024 Apr 29;13(4):540-551. doi: 10.21037/gs-24-90. Epub 2024 Apr 26.
Myasthenic crisis (MC) may occur after thymectomy in patients with myasthenia gravis (MG), but effective preventive interventions can reduce the occurrence of this complication. Previous research on MC focused on risk factors, emergency treatment, etc., which was relatively scattered and did not form a comprehensive management framework. This study sought to retrieve and summarize the relevant evidence on the prevention and management of postoperative MC to provide a theoretical reference for clinical medical staff.
According to the evidence pyramid model, relevant articles were retrieved from UpToDate, British Medical Journal (BMJ) Best Practice, World Health Organization (WHO), Scottish Intercollegiate Guidelines Network (SIGN), Guidelines International Network (GIN), Australian Joanna Briggs Institute (JBI) Healthcare Database, Medlive, PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang. The types of evidence included clinical guidelines, expert consensus articles, clinical decisions, systematic reviews, and randomized controlled trials (RCTs). The quality evaluations were conducted using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluation tool for guidelines, the Australian JBI Evidence-Based Healthcare Center evaluation tool for expert consensus articles, the Critical Appraisal for Summaries of Evidence (CASE) evaluation tool for clinical decisions, the Assessment of Multiple Systematic Reviews (AMSTAR) evaluation tool for systematic reviews, and the Cochrane risk-of-bias tool for RCTs.
A total of 12 articles were included in this study, including three clinical guidelines, three expert consensus articles, three clinical decisions, two systematic reviews, and one RCT. From these articles, we summarized 39 pieces of evidence on the prevention and management of postoperative MC.
This study summarized the best evidence on the prevention and management of postoperative MC and provided to clinical staffs evidence-based clinical approaches to help reduce the incidence of this complication.
重症肌无力（MG）患者胸腺切除术后可能发生重症肌无力危象（MC），但有效的预防干预措施可降低该并发症的发生率。既往关于MC的研究集中在危险因素、急救治疗等方面，较为零散，未形成综合管理框架。本研究旨在检索并总结术后MC预防和管理的相关证据，为临床医务人员提供理论参考。
根据证据金字塔模型，从UpToDate、英国医学杂志（BMJ）最佳实践、世界卫生组织（WHO）、苏格兰校际指南网络（SIGN）、指南国际网络（GIN）、澳大利亚乔安娜·布里格斯研究所（JBI）医疗保健数据库、医脉通、PubMed、考克兰图书馆、Embase、科学网、中国知网（CNKI）和万方数据库中检索相关文章。证据类型包括临床指南、专家共识文章、临床决策、系统评价和随机对照试验（RCT）。使用指南研究与评价II（AGREE II）评估工具对指南进行质量评估，使用澳大利亚JBI循证医疗保健中心评估工具对专家共识文章进行评估，使用证据总结的批判性评价（CASE）评估工具对临床决策进行评估，使用多个系统评价评估（AMSTAR）工具对系统评价进行评估，使用考克兰偏倚风险工具对RCT进行评估。
本研究共纳入12篇文章，包括3篇临床指南、3篇专家共识文章、3篇临床决策、2篇系统评价和1篇RCT。从这些文章中，我们总结出39条关于术后MC预防和管理的证据。
本研究总结了术后MC预防和管理的最佳证据，并为临床工作人员提供了循证临床方法，以帮助降低该并发症的发生率。
