300例重症肌无力患者胸腺切除手术的麻醉管理

发布时间：2018-07-26 14:06

【摘要】：目的分析300例重症肌无力(MG)患者胸腺切除手术的麻醉方式、探讨手术后需要呼吸支持的原因。方法随机选择2012年1月—2014年12月来该院进行治疗的300例重症肌无力胸腺切除术患者作为观察对象。根据患者术后是否需要呼吸机支持分为立刻拔管组266例和延迟拔管组34例,手术前给予溴吡斯的明口服,应用芬太尼、咪达唑仑、琥珀胆碱以及丙泊酚进行麻醉诱导,给予氧气、异氟烷以及氧化亚氮予以麻醉维持,不使用非去极化肌松剂。手术后8 h内小剂量给予溴吡斯的明,根据呼吸支持使用情况进行立即拔管或延迟拔管。回顾性分析患者的MG分型以及插管后的心率变化。结果两组患者的MG分型差异大(P0.05);同时,两组患者插管后1、5、30 min的心率对比差异小(P0.05);立刻拔管组的溴吡斯的明用量为(156.7±48.9)mg/d、明显少于延迟拔管组的(213.5±49.3)mg/d(P0.05)。结论 MG患者实施胸腺切除术过程中做好麻醉诱导与麻醉维持,能够保证麻醉的安全性,延迟拔管的发生率随着患者MG分型的上升而增加。
[Abstract]:Objective to analyze the anesthetic methods of thymectomy in 300 patients with myasthenia gravis (MG) and to explore the causes of respiratory support. Methods 300 patients with myasthenia gravis thymectomy were randomly selected from January 2012 to December 2014. The patients were divided into immediate extubation group (266 cases) and delayed extubation group (34 cases) according to whether they needed ventilator support after operation. They were given brompiridamine orally before operation and were induced by fentanyl, midazolam, succinylcholine and propofol. Oxygen, isoflurane and nitrous oxide were given to maintain anesthesia without non-depolarizing muscle relaxant. A small dose of brompiridamine was given within 8 hours after operation, and immediate extubation or delayed extubation was performed according to the use of respiratory support. The type of MG and heart rate after intubation were analyzed retrospectively. Results there was a significant difference in MG typing between the two groups (P0.05), at the same time, there was no significant difference in heart rate between the two groups at 30 min after intubation (P0.05), and the dosage of Bropiramide in the immediate extubation group was (156.7 卤48.9) mg / d, which was significantly lower than that in the delayed extubation group (213.5 卤49.3) mg/d (P0.05). Conclusion the induction and maintenance of anesthesia during thymectomy in MG patients can ensure the safety of anesthesia and the incidence of delayed extubation increases with the increase of MG classification.
【作者单位】：山东省新汶矿业集团莱芜中心医院手术室;
【分类号】：R614

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