血浆置换在重症肌无力患者围术期的应用及疗效.pdfVIP

中南大学学报(医学版) J Cem somh U Med scn 2007，32(6) 1O89 血浆置换在重症肌无力患者围术期的应用及疗效 (中南大学 1．湘雅医院输血科，长沙410008； ，刘建新沈亚梅 ，龚 伟 2．湘雅三医院心胸外科，长沙41O01 3) [摘要] 目的：探讨血浆置换在重症肌无力病人胸腺切除术围术期的应用，评价其疗效。方法：回 顾性分析我院胸外科胸腺切除术治疗的50例重症肌无力病人的临床资料，所有患者手术前后口服免 疫抑制剂、胆碱酯酶抑制剂；其中23例(A组)围术期进行血浆置换，另27例(B组)未进行血浆置换。 ELISA法测定两组患者外周血乙酰胆碱受体抗体(acetylcholine receptor antibodies，AChRab)的浓度；比较术 后外周血AChRab、临床记分、呼吸辅助时间、肌无力危象发生的差异。结果：A组患者术后AChRab浓度 明显下降，且术后l d和l周时A组患者AChRab浓度较 B组明显下降(P0．05)，术后1月时两组间 差异无统计学意义(P0．05)。A组患者术后呼吸辅助时间、肌无力危象的发生、术后 l周时临床记分 较 B组差异均有统计学意义(均P0．05)。结论：血浆置换配合胸腺切除术治疗可明显提高重症肌无 力患者近期疗效，是一种安全有效的治疗方法。 [关键词] 血浆置换； 胸腺切除； 重症肌无力 [中图分类号] R457．14 [文献标识码] A [文章编号] l672．7347(2007)06．1089．04 Application and curative effect of plasma exchange in myasthenia gravis patients with thymectomy SHEN Ya．mei ，GONG Wei。， LIU Jian．xin (1．Department ofBlood Transfusion，X~ngya Hospital，Central South University，Changsha 410008； 2．Department ofCardiothoracic Surgery，Third Xiangya Hospital，Central Somh University，Changsha 41O01 3，China) Abstract： 0bjective To explore the application of plasma exchange in myasthenia gravis (MG)patients with thymectomy，and to evaluate its curative effects．Methods The clinical data of 5 0 patients with thymectomy were analyzed retrospectively，and the patients were divided into Group A(23 cases，undergoing thymectomy and plasma exchange)and Group B(27 cases，undergoing thymectomy)．The difference of serum concentration of AChRab was examined by ELISA．and the time of auxiliary breath，crisis of myasthenia and clinical evaluation in the 2 groups were compared． Results Serum concentration of AChRab in Grou