Study On The Regularity Of Perioperative Symptoms Of Myasthenia Gravis

Background and ObjectiveMyasthenia gravis is an antibody-mediated autoimmune disease involving the acetylcholine receptors at the neuromuscular junction.The main manifestation is that the affected muscles are very prone to fatigue,and muscle strength is significantly reduced after contraction,including eye muscles,head and neck muscles,limbs muscles and respiratory muscles.A number of studies have shown that thymectomy is one of the most effective methods for the treatments of myasthenia gravis.However,at the initial onset of myasthenia gravis,the clinical manifestations of different patients will be significantly different due to the different involved muscle groups.After the disease,the affected muscles often change with the course of the disease and the progress of the disease,as well as the influence of external factors.In terms of drug control,there are natural differences in the susceptibility to anticholinesterase drugs among patients with myasthenia gravis.Therefore,the perioperative management of MG patients is complicated.So far,there is no systematic study on the perioperative symptoms of MG.In this study,the general progression order of MG affected muscle groups and the degree of impact on daily life and life were summarized and classified.And the drug sensitivity and disease condition of MG patients were classified.Through retrospective analysis of the data of MG patients who have been treated for surgical treatment,summarize and compare the differences in the admission classification,preoperative classification and postoperative classification.The purpose is to explore the perioperative change of clinical symptoms of MG,especially the rule of postoperative aggravation of MG symptoms and risk factors,so as to provide a theoretical basis for improving the safety and success rate of surgical treatment of MG.Materials and MethodsThe clinical data of 104 patients with myasthenia gravis who underwent thymectomy in the Second Affiliated Hospital of Zhengzhou University from January2015 to December 2019 were collected.The "Myasthenia Gravis Dynamic Assessment Method" was used to evaluate the dynamic classification,disease stage,and drug sensitivity classification of each patient "on admission","preoperative" and "postoperative",and recorded separately.The admission and preoperative symptom classification were compared and recorded in groups.Those with reduced symptoms are recorded in the "preoperative relief group",and those with stable symptoms are recorded in the "preoperative stable group".The preoperative and postoperative symptom classification were compared and recorded in groups.Those with worsening symptoms were recorded as "postoperative aggravate group",and those with reduced or stable symptoms were recorded as "postoperative stable group".Through descriptive statistical analysis,explored the perioperative symptoms of MG patients.Assessed the differences in surgical methods,preoperative symptomatic treatment,preoperative symptom classification,drug sensitivity classification,and disease stage between the postoperative aggravate group and the postoperative stable group.Explored the risk factors that affect postoperative symptoms of MG patients.Date processing was carried out by SPSS21.0.Result1.Compared the admission and preoperative symptoms of MG patients.Among104 patients who had undergone symptomatic treatment with preoperative medication.There were 68 cases in the preoperative relief group,accounting for 65.38%,and 36 cases in the preoperative stable group,accounting for 34.62%.The symptom types of patients in the preoperative relief group could be reduced by 1-2 types,all of which were drug-sensitive.2.Compared the preoperative and postoperative symptoms of MG patients.Among the 104 patients who underwent surgical treatment,there were 33 cases in the postoperative aggravate group,accounting for 31.73%,and there were 71 cases in the postoperative stable group,accounting for 68.26%.The postoperative symptom aggravation rates of patients who were type 0 before surgery were 20.45%.The postoperative symptom aggravation rates of patients who were type I before surgery were 26.47%.The postoperative symptom aggravation rates of patients who were type II before surgery were 57.14%.The postoperative symptom aggravation rates of patients who were type III before surgery were 58.33%.A total of 21 cases were aggravated by 1 type,9 cases were aggravated by 2 types,and 3 cases were aggravated by 3 types.There were 5 cases of aggravation on the first day after operation,9 cases of aggravation on the second day after operation,13 cases of aggravation on the third day after operation,and 6 cases of aggravation on the 4th day and later after operation.3.Patients in the postoperative aggravate group and the postoperative stable group were assessed for surgical risk.The results showed that the two groups had statistically significant differences in preoperative classification,drug sensitivity classification and disease stage(P<0.05).Logistic regression analysis showed that: the drug sensitivity classification,disease stage and type II and type III of preoperative symptom classification were statistically significant.Compared with the drug sensitive type,drug insensitive type patients had an increased risk of postoperative aggravation,OR=7.553,95% CI: [2.217,25.728].Compared with the stable stage patients,progressive stage patients had an increased risk of postoperative aggravation,OR=6.842,95% CI:[2.250,20.805].In terms of preoperative symptom classification,compared with the type 0,type II(OR=5.185,95% CI:[1.431,18.785])and type III(OR=5.444,95%CI:[1.395,21.244])had an increased risk of postoperative aggravation.Conclusion1.The clinical manifestations of MG patients are very different when they are admitted to the hospital.After perioperative treatment such as drugs,more than half of the patients’ symptoms can be relieved(the dynamic classification is reduced by 1-2types).After the operation,some patients’ clinical symptoms aggravate temporarily.The aggravation period occurres in 1-3 days after surgery,and the degree of aggravation is related to the severity of preoperative symptoms.According to the dynamic classification assessment,the symptom classification after operation is more aggravated by 1-2 types.2.The condition of the affected muscle group in MG patients(preoperative dynamic classification),whether the condition stable or not(preoperative stage of the disease),and drug sensitivity(preoperative type of drug sensitivity)are independent risk factors that affect the changes of postoperative symptoms of MG patients.