3.2 Reasonable adjustment of drug dosage and rational use of drugs, so that the patient's condition can be operated under stable conditions, which is very important for the patient's smooth recovery after operation. Patients with thymoma complicated with MG were given pyridostigmine 180 ~ 320 mg daily before operation, and taken 3 ~ 4 times. In the process of medication, let patients know the curative effect, dosage and time of medication, adjust dosage according to the condition, master the law of medication, stably control the symptoms of myasthenia gravis, and prepare for postoperative surgery. The dosage of anticholinesterase drugs and hormones should be reduced according to the condition after operation. Because postoperative patients are more sensitive to anticholinesterase drugs, cholinergic crisis is easy to occur, but MG crisis can also occur at the same time. Both of these crises can cause dyspnea and hypoxemia due to respiratory weakness, and it is difficult to distinguish them early after operation. Timely use of ventilator to assist breathing is the key to treatment [5].
3.3 Maintain the balance of nutrition, water and electrolyte, and instruct patients to eat soft food or semi-liquid food with high protein, high calorie, high vitamins and rich potassium and calcium; For those who can't swallow, instruct them to take a full rest before eating or eat after 15 ~ 30 min when the medicine takes effect. Those who can't eat are given nasal feeding or intravenous rehydration, and malnutrition is corrected before operation to maintain the balance of water and electrolyte.
3.4 Ensure adequate oxygen supply and effective oxygen supply after operation until the patient is conscious, spontaneous breathing is stable and muscle strength is restored. According to the oxygen saturation, it is better to adjust the oxygen supply concentration and flow rate to keep the oxygen saturation above 0.95. Delayed extubation in patients with oxygen saturation of 0.93 ~ 0.95, and preventive tracheotomy in patients below 0.93.
3.5 Strengthening respiratory tract management For patients with thymoma complicated with myasthenia gravis with high risk factors after operation, attention should be paid to respiratory tract care. Patients with increased laryngeal secretions after operation should thoroughly remove respiratory secretions. During sputum aspiration, the sputum aspiration tube extends into the bronchus to keep the respiratory tract unobstructed. Prolonging intubation time and auxiliary ventilation can significantly reduce the rate of tracheotomy, thus reducing the pain caused by tracheotomy and the chance of airway infection. Only patients with long-term mechanical ventilation can undergo tracheotomy. In this group, 7 patients with MG crisis underwent tracheal intubation and assisted ventilation, of which 1 patient underwent tracheotomy.
3.6 Rational use of antibiotics: anti-infection treatment should be given during perioperative period, sputum culture and drug sensitivity test should be conducted regularly, and reasonable and sensitive antibiotics should be selected to prevent lung infection, MG crisis and improve prognosis.
3.7 Observation of illness Because MG crisis mostly occurs in 24 ~ 48 h after operation, it is necessary to continuously and dynamically monitor the oxygen saturation after operation, and observe whether the patient's breathing depth, breathing mode, sputum volume and spontaneous expectoration are effective. For patients with median incision, special attention should be paid to whether there is bilateral pleural rupture. If you find that the breathing sounds of both lungs are asymmetrical after operation and you suspect secondary pneumothorax, you should report it to your doctor immediately. Patients with invasive thymoma of type ⅱb and above MG should be closely monitored within 72 hours after operation to deal with dyspnea and MG crisis in time. If necessary, extend the time of tracheal intubation or perform preventive tracheotomy to give auxiliary breathing, so that patients can safely spend the perioperative period.
3.8 contraindications after thymoma operation and careful use of drugs, muscle relaxants and central depressants, such as morphine, pethidine, barbiturates and chlorpromazine hydrochloride. And nerve and muscle blockers, such as aminoglycoside antibiotics, quinine, procainamide, propranolol, etc. , are banned, so these drugs all cause muscle weakness and crisis, making the condition worse.
3.9 Psychological nursing The postoperative symptoms of thymoma patients with MG sometimes cannot be relieved immediately, or even aggravated. Patients may show negative emotions such as fear and loss of confidence in treatment, which may cause or aggravate the occurrence of MG crisis. Psychological intervention should be given in time to eliminate their nervousness and fear, and explain to patients that these symptoms are only temporary, and as long as they cooperate with treatment, the symptoms will gradually improve. For MG crisis patients with tracheal intubation or tracheotomy, explain the purpose of various treatments, understand their psychological state and various needs by gestures or written communication, and minimize their fear.
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