Prognostic factors for myasthenic crisis after transsternal thymectomy in patients with myasthenia gravis
Prognostic factors for myasthenic crisis after transsternal thymectomy in patients with myasthenia gravis
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DOI：
10.1016/j.jtcvs.2003.07.036
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发表时间：
2004-03-01
影响因子：
6
通讯作者：
Abe, T
中科院分区：
文献类型：
--
作者：
Watanabe, A;Watanabe, T;Abe, T
目的：本研究的目的是评估重症肌无力患者的哪些临床特征可预测经胸骨胸腺切除术后因肌无力危象引起的术后呼吸问题。方法：对我院接受经胸骨胸腺切除术的122例患者进行回顾性分析。其中 14 名患者经历了肌无力危象，需要长时间（48 小时或更长时间）术后机械通气。评估以下因素：性别、年龄、体重指数、症状等级、疾病间隔、是否存在胸腺瘤、术前危象史、抗胆碱酯酶药物剂量、类固醇使用、肺功能、血清抗乙酰胆碱受体抗体、肺部疾病史、是否存在其他疾病、手术时间和失血量。 结果：单变量分析显示术前延髓症状 （比值比 = 14.246，P = .001）、术前肌无力危象病史（7.091，.018）和术前血清抗乙酰胆碱受体抗体水平 > 100 nmol/L（4.098，.044）是术后肌无力危象的预后因素。另一方面，多变量logistic回归分析显示，术前延髓症状（33.333，.004）、术前血清抗乙酰胆碱受体抗体水平> 100 nmol/L（7.874，.020）和术中失血量> 1000 mL（18.519，.048）是术后肌无力的预后因素 结论：本研究中，122例重症肌无力患者经胸骨胸腺切除术后出现肌无力危象，与术前是否存在延髓症状、术前有肌无力危象病史、术前血清抗乙酰胆碱受体抗体水平>100nmol/L、术中失血量>1000mL等因素有关。应进行细致的术前和术后护理，以防止具有这些预后因素的患者发生术后肌无力危象。
Objective: The purpose of this study was to assess which clinical features of patients with myasthenia gravis predict postoperative respiratory problems due to myasthenic crisis after transsternal thymectomy.Methods: One hundred twenty-two patients who underwent traussternal thymectomy in our institute were analyzed retrospectively. Fourteen of those experienced myasthenic crisis and required prolonged (48 hours or more) postoperative mechanical ventilation. The following factors were evaluated: sex, age, body mass index, grade of symptom, disease interval, existence of thymoma, history of preoperative crisis, doses of anticholinesterase drugs, steroid use, pulmonary function, serum anti-acetylcholine receptor antibody, history of pulmonary disease, presence of other disease, operation time, and blood loss.Results: Univariate analysis revealed preoperative bulbar symptoms (odds ratio = 14.246, P = .001), history of preoperative myasthenic crisis (7.091, .018), and preoperative serum level of anti-acetylcholine receptor antibody > 100 nmol/L (4.098, .044) were prognostic factors for postoperative myasthenic crisis. On the other hand, multivariate logistic regression analysis revealed preoperative bulbar symptoms (33.333, .004), preoperative serum level of anti-acetylcholine receptor antibody > 100 nmol/L (7.874, .020), and intraoperative blood loss > 1000 mL (18.519, .048) were prognostic factors for postoperative myasthenic crisis.Conclusions: In this study, postoperative myasthenic crisis after transsternal thymectomy in 122 patients with myasthenia gravis was affected by the existence of preoperative bulbar symptoms, history of preoperative myasthenic crisis, preoperative serum level of anti-acetylcholine receptor antibody > 100 nmol/L, and intraoperative blood loss > 1000 mL. Meticulous preoperative and postoperative care should be carried out to prevent postoperative myasthenic crisis in patients with these prognostic factors.