Zhang Yan, Zhou Ronghua
Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, P.R. China.
Perfusion. 2019 Sep;34(6):490-494. doi: 10.1177/0267659119833230. Epub 2019 Mar 7.
Malignant hyperthermia is a well-known but potentially lethal disorder which is triggered by volatile anesthetics and depolarizing muscle relaxants. Early diagnosis and treatment could save lives. However, during cardiac surgery, hypothermia and cardiopulmonary bypass make the diagnosis of malignant hyperthermia extremely difficult than other surgeries. We report a case of almost-certain malignant hyperthermia, according to the clinical grading scale, in a patient undergoing on-pump coronary artery bypass grafting surgery. The patient underwent difficult weaning from cardiopulmonary bypass until intra-aortic balloon pump and temporary cardiac pacemaker had been implanted. Although dantrolene and corresponding treatments were administered recently, the patient died 12 days after surgery because of acute kidney failure and cardiac arrest. Therefore, it is important for us to previously recognize some specific signs of malignant hyperthermia during cardiopulmonary bypass to avoid severe outcomes.
恶性高热是一种广为人知但可能致命的疾病，由挥发性麻醉剂和去极化肌松药引发。早期诊断和治疗可挽救生命。然而，在心脏手术期间，低温和体外循环使得恶性高热的诊断比其他手术极为困难。我们报告一例在接受体外循环冠状动脉搭桥手术的患者中，根据临床分级量表几乎确诊为恶性高热的病例。该患者在植入主动脉内球囊泵和临时心脏起搏器之前，经历了困难的体外循环撤机过程。尽管最近给予了丹曲林及相应治疗，但患者术后12天因急性肾衰竭和心脏骤停死亡。因此，对我们而言，在体外循环期间预先识别恶性高热的一些特定体征以避免严重后果很重要。
