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重症肌无力患者的麻醉

Authors
Riki Kveraga, MD
John Pawlowski, MD, PhD
Section Editors
Stephanie B Jones, MD
Jeremy M Shefner, MD, PhD
Deputy Editors
Marianna Crowley, MD
John F Dashe, MD, PhD
Translators
何振洲, 主任医师

引言

重症肌无力(myasthenia gravis, MG)是一种自身免疫性疾病，以骨骼肌易出现疲劳性肌无力为特征。骨骼肌无力由针对神经肌肉接头突触后膜的乙酰胆碱受体(或受体相关蛋白)的抗体介导性免疫攻击引起。

MG患者中的麻醉问题包括下列因素的相互影响：疾病、疾病的治疗和麻醉用药物，尤其是神经肌肉阻断药(neuromuscular blocking agent, NMBA)。MG患者对非去极化NMBA具有不可预测的敏感性，但对琥珀胆碱(一种去极化NMBA)耐药。

Lambert-Eaton肌无力综合征(Lambert-Eaton myasthenic syndrome, LEMS)是一种罕见的神经肌肉接头自身免疫性疾病，该病中机体产生了攻击突触前电压门控性钙离子通道的抗体。该病常与基础恶性肿瘤有关，最常为小细胞肺癌，但也与其他自身免疫性疾病有关。LEMS患者对去极化和非去极化NMBA都非常敏感。

本专题将讨论MG和LEMS患者的麻醉处理，MG和LEMS的诊断、临床表现和治疗将单独详细讨论。 (参见“重症肌无力的诊断”和“重症肌无力的临床表现”和“重症肌无力的治疗”和“Lambert-Eaton肌无力综合征的临床特征及诊断”和“Lambert-Eaton肌无力综合征的治疗”)

术前评估

MG患者的择期手术术前准备应该与患者的神经科医师共同决定。应在该病的稳定期实施择期手术，此期患者所需的免疫调节药物或糖皮质激素均为处于最低水平，这样可最大程度减少术后肌无力危象(myasthenic crisis, MC)的可能性。除了常规的术前评估以外，MG患者的评估还应重点关注延髓症状和呼吸系统症状，以及既往疾病发作或MC病史。手术应尽可能安排在当日的早些时候，此时患者的肌力状态最佳[1]。

                         

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Literature review current through: 2017-06 . | This topic last updated: 2017-03-07.
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