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目的探讨全身型重症肌无力(MG)患者胸腺扩大切除术后危象的影响因素。方法对176例全身型 MG 患者术后危象的影响因素采用病例-对照研究的方法。36例发生术后危象。研究项目包括:性别、手术时年龄、手术时病程、胸腺病理类型、手术时受累部位、手术时临床分型(Osserman 分型)、术前感染史(术前1个月内)、术前危象史(术前1个月内)、术前吡啶斯的明用量(mg/d)、术前激素使用情况、手术持续时间(min)、手术过程的出血量(ml)、手术时胸膜破损情况。结果单因素分析显示:术前吞咽肌受累(OR=8.494,P=0.001),术前危象史(OR=5.667,P=0.000),胸腺瘤(OR=2.147,P=0.047),Ⅲ、Ⅳ型(OR=4.549,P=0.000),术前感染史(OR=3.30,P=0.038),术前吡啶斯的明用量大(OR=1.019,P=0.001),手术持续时间长(OR=1.012,P=0.034),出血量多(OR=1.004,P=0.012)为术后发生危象的危险因素,进行 Logistic 回归模型多因素分析显示:术前吞咽肌受累(OR=7.709,P=0.003)、术前感染史(OR=4.582,P=0.037)、术前危象史(OR=4.526,P=0.001)、术前吡啶斯的明用量大(OR=1.016,P=0.01)是术后发生危象的独立影响因素。结论术前吞咽肌受累、术前感染史、术前危象史、术前吡啶斯的明用量大是术后发生危象的独立影响因素。术前做好充分准备,尽可能降低术后危象的发生。
Objective To investigate the influencing factors of crisis after thymus enlargement resection in patients with systemic myasthenia gravis (MG). Methods 176 cases of systemic MG patients with postoperative crisis factors using case-control study. Thirty-six patients had postoperative crisis. The research items include: sex, age at surgery, duration of surgery, pathological types of thymus, locations involved in surgery, clinical classification (Osserman classification) at surgery, history of preoperative infection (within 1 month before surgery), preoperative risk Preoperative pyridostigmine (mg / d), preoperative hormone use, duration of surgery (min), amount of bleeding during surgery (ml), pleural damage at the time of surgery Happening. Results Univariate analysis showed that preoperative swallowing muscle involvement (OR = 8.494, P = 0.001), preoperative crisis history (OR = 5.667, P = 0.000), thymoma (OR = 2.147, (OR = 4.549, P = 0.000), preoperative infection history (OR = 3.30, P = 0.038), premedication dosage of pyridostigmine (OR = 1.019, P = 0.001) (OR = 1.004, P = 0.012) were the risk factors of postoperative crisis. The multivariate analysis of logistic regression model showed that the swallowing muscle involvement was preoperative (OR = 7.709, P (OR = 4.526, P = 0.001), preoperative infection history (OR = 4.582, P = 0.037) Is an independent risk factors for postoperative impact. Conclusions Preoperative swallowing muscle involvement, preoperative infection, preoperative risk of crisis, preoperative pyridostiline dosage is an independent risk factors for postoperative crisis. Preoperative well prepared to minimize the occurrence of postoperative crisis.