Hor Jyh Yung
Department of Internal Medicine, Sultanah Bahiyah Hospital, Alor Star, Kedah, Malaysia.
Middle East J Anaesthesiol. 2010 Oct;20(6):881-3.
We report a case of cardiac arrhythmia occurring in a Guillain-Barré syndrome (GBS) patient after succinylcholine administration during third endotracheal intubation, on day 13 of illness. The probable cause of arrhythmia is succinylcholine-induced hyperkalemia. Of interest, this case demonstrated in the same patient that arrhythmia only occurred during third intubation, when duration of illness is prolonged, and not during previous two intubation episodes, despite succinylcholine was also being used. In GBS, muscle denervation resulted in up-regulation of acetylcholine receptors at neuromuscular junctions, causing the muscle cell membrane to become supersensitive to succinylcholine, leading to severe hyperkalemia and arrhythmia when succinylcholine was administered.
我们报告一例格林-巴利综合征（GBS）患者，在患病第13天进行第三次气管插管时给予琥珀酰胆碱后发生心律失常。心律失常的可能原因是琥珀酰胆碱诱导的高钾血症。有趣的是，该病例表明，在同一患者中，心律失常仅发生在病程延长的第三次插管期间，而在前两次插管期间未发生，尽管也使用了琥珀酰胆碱。在GBS中，肌肉失神经支配导致神经肌肉接头处乙酰胆碱受体上调，使肌肉细胞膜对琥珀酰胆碱变得超敏，在给予琥珀酰胆碱时导致严重高钾血症和心律失常。
