Karger B, Teige K
Institute of Legal Medicine, University of Münster, Röntgenstrasse 62, 48149 Münster, Germany.
Forensic Sci Int. 2002 Oct 9;129(3):187-90. doi: 10.1016/s0379-0738(02)00272-4.
A case of malignant hyperthermia (mh) in a 27-year-old man is described. In a first anaesthesia using isoflurane and succinylcholine, the end-tidal CO(2) rose from 39 to 49 mmHg 2.75 h post-intubation and the body temperature rose to 39.8 degrees C 14 h post-intubation but was normal again the next day. In a second anaesthesia using the same medication, the maximal end-tidal CO(2) was 44 mmHg and the body temperature rose to 39 degrees C after 9 h. After 4 days, the fever rose to 40 degrees C, and to 42 degrees C when death occurred 10 days after the second anaesthesia. Masseter spasms or muscle rigidity were never present. According to the death certificate, death was due to multi-organ failure from sepsis. At autopsy, the skeletal muscles were pale and oedematous. Histology demonstrated focal necroses in the skeletal muscles, shock kidneys with myoglobin excretion and myoglobin clots in small blood vessels of the lungs. Hence, the postmortem diagnosis "malignant hyperthermia" was established but accusations of medical maltreatment were rejected because of the atypical and protracted clinical course and because uncharacteristic signs of malignant hyperthermia were attributable to the clinically suspected sepsis.
本文描述了一名27岁男性的恶性高热（MH）病例。在首次使用异氟烷和琥珀酰胆碱进行麻醉时，插管后2.75小时呼气末二氧化碳分压从39 mmHg升至49 mmHg，插管后14小时体温升至39.8℃，但第二天恢复正常。在第二次使用相同药物进行麻醉时，呼气末二氧化碳分压最高为44 mmHg，9小时后体温升至39℃。4天后，体温升至40℃，第二次麻醉10天后死亡时体温升至42℃。从未出现咬肌痉挛或肌肉强直。根据死亡证明，死亡原因是败血症导致的多器官衰竭。尸检时，骨骼肌苍白且水肿。组织学显示骨骼肌有局灶性坏死、休克性肾伴肌红蛋白排泄以及肺小血管内有肌红蛋白凝块。因此，尸检诊断为“恶性高热”，但由于临床病程不典型且迁延，以及恶性高热的非典型体征归因于临床怀疑的败血症，医疗不当指控被驳回。
