重症肌无力危象缩短机械通气时间的策略研究

摘要

Objective To identify the clinical and demographical features that may impact the duration of mechanical ventilation(DMV) in the patients with post-thymectomy myasthenic crisis(PTMC).Methods Reviewed the patients who had PTMC from June 2008 to November 2015.Cox proportional hazard regression analysis was used to identify potential prognostic factors that may impact DMV and long-term survival,respectively.One-way ANOVA analysis was used to compare the four groups with continuous variates.Statistical powers were calculated by using XLSTAT.Results In total,seventy patients with PTMC were enrolled.Alcoholic abuse,high MGFA classification and Clavien-Dindo classification were the critical factors that remarkably delayed early extubation.Postoperative lung infection(PLI) as sole complication did not prolong DMV as compared to those without any complication,however,PLI with other more severe complications requiring at least pharmacological treatment seemed to remarkably prolong DMV,as compared to those without any complication.Conclusion Preoperative abstinence,proper treatment of MG and postoperative complications can decrease the incidence of PTMC,shorten the use of ventilator time and improve the prognosis of patients.%目的 分析重症肌无力(myasthenia gravis,MG)胸腺扩大切除术后发生肌无力危象(postthymectomy myasthenic crisis,PTMC)机械通气时间(duration of mechanical ventilation,DMV)的相关因素探讨缩短DMV的治疗策略.方法 回顾性分析2008年6月至2015年11月经第三军医大学大坪医院胸外科胸腺扩大切除术后发生PTMC患者,Cox回归分析DMV的影响因素,One-way ANOVA分析并发症对DMV的影响,Cox回归分析和One-way ANOVA分析的统计权重采用XLSTAT软件计算.结果 384例MG接受胸腺扩大切除患者中70例发生PTMC.术前酒精依赖、美国重症肌无力协会(Myasthenia Gravis Foundation America,MGFA)分型以及术后Clavien并发症分级是导致术后DMV延长的主要原因,PLI合并其他2级以上并发症是延长DMV的重要因素,单纯术后肺部感染(postoperative lung infection,PLI)不延长DMV.结论 PTMC治疗主要依赖于呼吸机辅助呼吸.术前戒酒、恰当的MG治疗以及术后并发症的控制,可减少PTMC,亦可缩短呼吸机使用时间,改善患者预后.