Gracey D R, Divertie M B, Howard F M, Payne W S
Chest. 1984 Jul;86(1):67-71. doi: 10.1378/chest.86.1.67.
During a three-year period, 53 patients with myasthenia gravis underwent transsternal thymectomy by a partial sternum-splitting technique at our institution. This procedure was carried out (1) because an x-ray film or a computed tomography scan had suggested the presence of a thymoma or (2) to manage symptoms of myasthenia gravis. In 41 patients the endotracheal tube was removed in the post-anesthesia recovery room. The remaining 12 patients were extubated in the Respiratory Care Unit--in five, after prolonged mechanical ventilation. From our experience, the only factor useful for predicting the probable need for prolonged postoperative mechanical ventilation is the degree of bulbar involvement. Patients in Osserman classification groups 3 and 4 have an extremely high incidence of postoperative respiratory failure. Consideration should be given to the use of preoperative plasmapheresis in myasthenia gravis patients who have significant bulbar symptoms.
在三年时间里，我院有53例重症肌无力患者采用部分胸骨劈开技术接受了经胸骨胸腺切除术。进行该手术的原因如下：（1）X线片或计算机断层扫描提示存在胸腺瘤；（2）控制重症肌无力症状。41例患者在麻醉后恢复室拔除气管插管。其余12例患者在呼吸监护病房拔管，其中5例是在长时间机械通气之后。根据我们的经验，预测术后可能需要长时间机械通气的唯一有用因素是延髓受累程度。Osserman分类3组和4组的患者术后呼吸衰竭发生率极高。对于有明显延髓症状的重症肌无力患者，应考虑术前进行血浆置换。
