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[恶性高热;两例在全身麻醉下发生恶性高热并进行咖啡因挛缩试验的病例]

[Malignant hyperthermia; two cases of MH in the presence of general anesthesia and performing caffeine contracture test].

作者信息

Tateishi M, Sumita S, Watanabe H, Kumeta H, Narimatsu E, Namiki A

出版信息

Masui. 1989 Apr;38(4):546-51.

PMID:2724520
Abstract

In the present report we described two cases of malignant hyperthermia under halothane anesthesia. Case 1; A 54-year-old, 58 kg-male was scheduled for the operation of giant arterio-venous malformation. Anesthesia was induced with thiamylal, fentanyl and pancuronium, and maintained with oxygen, nitrous oxide and halothane. The patient was subjected to halothane inhalation for 26 hours prior to the development of the malignant hyperthermia. Although body temperature rose to 41 degrees C, it returned to normal with the administration of 280 mg of dantrolene and systemic cooling. Case 2; A 31-year-old, 68 kg-female was scheduled for tonsillectomy. Anesthesia was induced with thiamylal, oxygen, nitrous oxide and halothane. After the administration of 70 mg of SCC, marked muscular rigidity occurred and endotracheal intubation was impossible. The operation was postponed. Two months after the first anesthesia, operation was successfully performed under NLA with droperidol and fentanyl. Caffeine contracture test was performed in each case by skinned fiber method and the result showed that the sensitivity to caffeine increased in the isolated skeletal muscle fiber bundles from these patients. Thresholds of caffeine contracture of these skinned fiber bundles were all lower than 5mM caffeine.

摘要

在本报告中,我们描述了两例氟烷麻醉下的恶性高热病例。病例1:一名54岁、体重58公斤的男性计划接受巨大动静脉畸形手术。麻醉诱导采用硫喷妥钠、芬太尼和潘库溴铵,维持采用氧气、氧化亚氮和氟烷。在发生恶性高热之前,该患者接受氟烷吸入26小时。尽管体温升至41摄氏度,但通过给予280毫克丹曲林和全身降温后恢复正常。病例2:一名31岁、体重68公斤的女性计划接受扁桃体切除术。麻醉诱导采用硫喷妥钠、氧气、氧化亚氮和氟烷。给予70毫克琥珀胆碱后,出现明显的肌肉强直,无法进行气管插管。手术推迟。首次麻醉两个月后,在使用氟哌利多和芬太尼的神经安定镇痛麻醉下成功进行了手术。对每个病例采用皮肤纤维法进行咖啡因挛缩试验结果显示,这些患者分离的骨骼肌纤维束对咖啡因的敏感性增加。这些皮肤纤维束的咖啡因挛缩阈值均低于5毫摩尔咖啡因。

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