Milne B, Rosales J K
Can Anaesth Soc J. 1982 May;29(3):250-4. doi: 10.1007/BF03007125.
Charts of nine patients with Duchenne and one with Becker's muscular dystrophy who had undergone spinal fusion and Harrington rod insertion for scoliosis were reviewed retrospectively. The mean age was 15 years and mean angle of scoliosis was 69 degrees. Preoperative pulmonary function studies showed a restrictive defect with a mean vital capacity of 1.3 +/- 0.69 litres, 35 +/- 20 per cent of predicted value, 33 +/- 20 ml . kg-1 and a mean inspiratory capacity of 0.99 +/- 0.5 litres, 23 +/- 13 ml . kg-1. There were no anaesthetic complications during operation and obstructive cardiomyopathy, hyperpyrexia, hyperkalaemia and rhabdomyolysis were not problems. Succinylcholine was avoided. One patient developed an arrhythmia postoperatively and one patient whose postoperative problems included tracheostomy, pneumonia and sepsis could not be weaned from the ventilator and died 11 weeks after operation. As assessing risk and survival of the operation depends on objective pulmonary function, a vital capacity of at least 20 ml . kg-1 in the range of 30 per cent of predicted volume with an inspiratory capacity of at least 15 ml . kg-1 would appear to be adequate in patients with muscular dystrophy requiring Harrington rod insertion. Other factors including the rapidity of progression of the muscular disease, other respiratory and cardiovascular problems, and disease such as obesity should also be considered.
对9例杜氏肌营养不良症患者和1例贝克型肌营养不良症患者的病历进行了回顾性研究，这些患者因脊柱侧弯接受了脊柱融合术和哈灵顿棒植入术。平均年龄为15岁，平均脊柱侧弯角度为69度。术前肺功能研究显示存在限制性缺陷，平均肺活量为1.3±0.69升，为预测值的35±20%，33±20毫升·千克⁻¹，平均吸气量为0.99±0.5升，23±13毫升·千克⁻¹。手术期间无麻醉并发症，未出现梗阻性心肌病、高热、高钾血症和横纹肌溶解症等问题。避免使用琥珀酰胆碱。1例患者术后出现心律失常，1例患者术后出现气管切开、肺炎和败血症等问题，无法撤机，术后11周死亡。由于评估手术风险和生存率取决于客观肺功能，对于需要植入哈灵顿棒的肌营养不良症患者，肺活量至少20毫升·千克⁻¹，在预测值的30%范围内，吸气量至少15毫升·千克⁻¹似乎就足够了。还应考虑其他因素，包括肌肉疾病进展的速度、其他呼吸和心血管问题以及肥胖等疾病。
