| Background and Purpose Myasthenia gravis(MG)is an autoimmune disease that is mediated by immune antibodies and involves neuromuscular junction-induced signal transduction dysfunction.The main manifestation is fatigue of muscles in the whole body,with skeletal muscle involvement as the most important.If not treated in time,the disease will gradually worsen.Later,respiratory and eating weakness can occur,which seriously affects the quality of life of patients and even endangers their lives.Currently,most studies have shown that surgical treatment of myasthenia gravis is an effective treatment.However,due to the particularity of the disease,the complications associated with surgery are much higher than other diseases.Myasthenia gravis crisis is the most serious complication after operation.Once it happens,emergency ventilation is usually needed,which has a high mortality rate.Therefore,prevention of serious complications after myasthenia gravis surgery is an unavoidable task for thoracic surgeons.Rational perioperative management and scientific timing of operation are the best strategies to prevent serious complications after operation.This study retrospectively evaluates the advantages and disadvantages of preoperative surgical evaluation system for myasthenia gravis and traditional perioperative management concepts and methods of myasthenia gravis,with a view to providing scientific basis for the timing of surgery and perioperative management of patients with myasthenia gravis and avoiding the occurrence of serious complications after surgery.Objects and Methods 123 patients with MG admitted from September 2013 to November 2018 were summarized and analyzed.They were divided into experimental group and control group according to different perioperative management methods and concepts.The experimental group used the surgical evaluation system of myasthenia gravis to guide the selection of surgical indications and perioperative management of MG patients,while the control group used the traditional perioperative management method to carry out perioperative management of MG patients.To evaluate the difference of the incidence of myasthenia gravis crisis,the aggravation rate of symptoms,the rate of pulmonary infection,the length of catheterization after operation,the length of hospitalization after operation and the total cost of hospitalization between the two groups.Comparing the patients with aggravated symptoms after operation with those with stable symptoms after operation,the risk factors affecting the aggravation of MG patients after operation were explored by single multivariate analysis.Through descriptive statistical analysis,we can understand the general rule of the aggravation of symptoms after operation.Data processing and analysis are carried out by SPSS 25.0 statistical software.Results 1.There were no significant differences in gender,age,duration of disease,surgical MG classification and past crisis history between the two groups at admission.After perioperative intervention,7 patients in the experimental group were still in a highrisk state and conservative treatment was chosen.Finally,54 patients in the experimental group and 62 patients in the control group underwent surgical treatment.There were significant differences in preoperative symptom control rate(74.07% VS 38.71%),stage of illness(remission stable stage,100.00% VS remission stable stage,79.03%),operative method(thoracoscopy,88.89% VS thoracoscopy,67.74%)and postoperative analgesic effect(satisfactory,81.48% VS satisfactory,64.52%)between the two groups.2.There was no myasthenia gravis crisis after MG operation in the experimental group and 3 cases in the control group.Compared with the control group,there were significant differences in MG symptoms aggravation rate(12.96% VS 38.71%),pulmonary complications rate(11.11% VS 27.42%),hospitalization days(7.76±1.78 VS 9.84±4.07),total hospitalization costs(RMB3.21±1.14 thousand VS RMB3.79±1.06 thousand)and other outcome indicators between the experimental group and the control group.Univariate and multivariate analysis showed that preoperative high-risk MG patients,thoracotomy and poor analgesic effect were risk factors for worsening symptoms of MG patients.Among them,preoperative high-risk MG patients,poor analgesic effect was an independent risk factor for worsening symptoms after operation.3.Univariate and multivariate analysis showed that preoperative high-risk MG patients,thoracotomy and poor analgesic effect were risk factors for worsening symptoms of MG patients.Among them,preoperative high-risk MG patients,poor analgesic effect was an independent risk factor for worsening symptoms after operation.4.The higher the preoperative surgical classification of MG patients,the more prone the symptoms to worsen after operation.Most of them aggravate one type.The aggravation time usually occurs in the first three days after operation,especially in the second and third days after operation.Conclusions 1.Preoperative surgical risk assessment system for myasthenia gravis has a good application value in guiding individualized perioperative management and preventing post-operative crisis and serious complications of MG patients.Scientific and reasonable perioperative management can effectively reduce the surgical risk level of MG.2.Two to three days after operation is the main period of aggravation of symptoms in MG patients.For MG patients with higher preoperative type,attention should be paid to prevent the occurrence of post-operative myasthenia crisis. |
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