| Background and PurposeMyasthenia gravis(MG)is an autoimmune disease caused by antibodies binding directly to the acetylcholine receptor(anti-AchR)in neuromuscular junction(NMJ)postsynaptic membrane.Extended thymectomy is the first choice method for the treatment of MG,which is 72 to 95 percent effective ration.Myasthenia crisis(myasthenic crisis,MC)refers to the progression of the MG patients themselves or insufficient anticholinesterase drugs or some other factors,causes difficulty in breathing,needs help to breathe.MC can occur before or after the operation,and it is affected by many factors.Postoperative MC is the most serious complications in extended thymectomy,is also one of the main cause of postoperative death.Regulation and reasonable perioperative managements can reduce the occurrence of postoperative MC.However,there is no consensus on the methods of perioperative management of MG.Since 1980 s,my department had done a lot of research on MG and accumulated rich clinical experience.In this study,we retrospectively collected the clinical data of patients with MG form 2012.08 to 2017.02 who underwent extended thymectomy in our department,summarized perioperative management experience and analyzed the risk foctors of preoperative MC in order to provide theoretical basis for guiding MG perioperative managements.Objects and MethodsThe enrolled 135 patient were from department of thoracic surgery,the Second Affiliated Hospital of Zhengzhou University from 2012,08 to 2017,02,to summarize the experience of perioperative management.Comparison the incidence of MC in the other six units contemporaneous which adopted traditional management methods,and comparison the incidence of MC with our department from 1993.06 to 2002.05 when used past management measures.Then,divided the patients into two groups according to the occurrence of MC,from the gender,age,course of disease,the use of hormone,hormone dosage,pyridostigmine bromide dosage,modified Osserman classification,clinical stage,crisis history,accompanied with autoimmune diseases such as hyperthyroidism,accompanied with thymoma,accompanied with other diseases such as hypertension,surgical methods and infection 13 aspects to explore the dangerous factors of the MC.Student’s t test or Fisher exact test were used to compare the differences of observation indexes of the two groups and logistic regression model was used to analyze the independent risk factors of MC.Results1.The principle of perioperative management is controlling the symptoms of MG to the lightest and avoiding the occurrence of aggravating factors of MG.The criterion of operation time is based on clinical staging and surgery is performed at a stable remission stage.In the 135 patients,6 cases developed MC before operation and recovered after treatment.The 135 patients underwent surgical treatment according to the perioperative management,no postoperative MC occurred and the incidence of MC after operation was 0.Which is significantly lower than the incidence MC in six other medical units during the same period.Incidence rate of MC for six other medical units was 18.6%,19.0%,14.3%,14.4%,18.2%,14.4%.It is also significantly lower than our department from 1993.06 to 2002.05,when the rate was9.9%.2.Single factor analysis,they were no statistically significant difference in the gender,age,course of disease,the use of hormone,hormone dosage,pyridostigmine bromide dosage,modified Osserman classification,clinical stage,crisis history,accompanied with autoimmune diseases such as hyperthyroidism,accompanied with thymoma,accompanied with other diseases(such as blood pressure)(P>0.05).Incidence of MC in developing patients was significant higher than that of stable patients(P<0.05).Patients with a history of previous crisis MC was obviously higher than that of patients with no history of crisis(P<0.05).Compared with no infection,incidence of MC for the infection patients was significant increased(P<0.05).Logistic regression analysis showed that the clinical stage,a history of previous crisis and infection were independent risk factors for incidence of MC(P=0.004,OR=23.743,95%CI: 2.803-201.154;P=0.035,OR=14.151,95%CI:1.207-165.928;P=0.035,OR=14.151,95%CI: 1.207-165.928).Conclusion1.Perioperative to control MG symptoms to a minimum,to avoid the occurrence of aggravating factors of MG and to choice of stable/remission stage for operation timing was the key to reduce incidence of postoperative MC.2.The clinical progressive stage,a history of previous crisis and infection were independent risk factors for incidence of MC. |
