Leventhal S R, Orkin F K, Hirsh R A
Anesthesiology. 1980 Jul;53(1):26-30. doi: 10.1097/00000542-198007000-00006.
In order to determine predictors for the postoperative need of mechanical ventilation in patients with myasthenia gravis undergoing thymectomy, the authors retrospectively applied multivariate discriminant analysis to preoperative physical, historical, and laboratory data of 24 myasthenic patients. They identified four risk factors--duration of myasthenia, respiratory disease, pyridostigmine dosage, and vital capacity--that allowed prediction of which patients would need postoperative mechanical ventilation and which could readily have their tracheas extubated. The four factors were weighted according to their respective importance in making this prediction and combined to form a preoperative scoring system. Using the resultant scores for each patient, the authors correctly predicted ventilatory need in 91 per cent of the patients, and only conservative errors (predicting the need for ventilatory support) were made. Traditionally used criteria for evaluating myasthenic patients were poorer predictors than the four factors identified by the authors. The scoring system may be clinically useful in the preoperative evaluation and postoperative care of the patient with myasthenia gravis, for its identifies important variables in the evaluation of the myasthenic patient and serves as an aid to the physician in identifying those able to tolerate early tracheal extubation.
为了确定接受胸腺切除术的重症肌无力患者术后机械通气需求的预测因素，作者对24例重症肌无力患者术前的身体状况、病史和实验室数据进行了回顾性多变量判别分析。他们确定了四个风险因素——重症肌无力病程、呼吸系统疾病、吡啶斯的明剂量和肺活量，这些因素能够预测哪些患者术后需要机械通气，哪些患者可以顺利拔管。根据这四个因素在进行该预测中的各自重要性进行加权，并组合形成一个术前评分系统。利用每个患者的最终得分，作者正确预测了91%患者的通气需求，且仅出现了保守性错误（预测需要通气支持）。传统上用于评估重症肌无力患者的标准，其预测能力不如作者确定的这四个因素。该评分系统在重症肌无力患者的术前评估和术后护理中可能具有临床实用性，因为它识别了评估重症肌无力患者时的重要变量，并有助于医生识别那些能够耐受早期气管拔管的患者。
