von Richthofen V, Wappler F, Scholz J, Fiege M, Schulte am Esch J
Klinik für Anästhesiologie, Universitäts-Krankenhaus Hamburg-Eppendorf.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1998 Apr;33(4):244-9.
The Clinical Grading Scale (CGS) was introduced to predict malignant hyperthermia (MH) susceptibility in adverse anaesthetic events. Because many of the clinical symptoms that occur during MH episodes are nonspecific, the CGS was designed as a tool to estimate the qualitative likelihood of MH. The purpose of this study was to compare the results of the CGS with the established in vitro contracture test (IVCT).
92 patients with a personal history for MH were tested for MH susceptibility with the IVCT according to the protocol of the European MH Group. All patients were also evaluated with the CGS. Clinical indicators for the CGS are rigidity, muscle breakdown, respiratory acidosis, temperature increase and cardiac involvement. There are additional indicators in case of a family history for MH. For each indicator 3-15 points are added to build a raw score; this raw score corresponds to a MH rank in the CGS that describes the likelihood of MH in the suspected event. The higher the raw score rank, the higher the likelihood of MH and vice versa.
From 92 patients, 32 (35%) were diagnosed as MH-susceptible (MHS) with the IVCT, 47 (51%) were MH-normal (MHN), and 13 (14%) were MH-equivocal (MHE). One patient with MH-rank 1 (MH almost never) in the CGS was diagnosed as MHS; on the other hand no patient with MH-rank 6 (MH almost certain) in the CGS was diagnosed as MHN. However, the majority of patients (72%) were assigned to ranks 3 and 4 (MH somewhat less than likely/MH somewhat greater than likely). The qualitative likelihood of MH could therefore not be clearly estimated.
Our study shows that the MH-rank of the CGS corresponds poorly with the results of the IVCT. In any case the evaluation of an MH suspicious event depends on the availability of data of that event. It is often difficult to obtain sufficient data, especially if the event occurred a long while ago. In these cases the MH rank may underestimate the likelihood of MH susceptibility. On the other hand, overestimation is also possible because some of the scoring indicators depend on the anaesthesiologist's judgement only. At present, the use of the CGS is neither validated nor clinically feasible. The CGS cannot replace IVCT.
引入临床分级量表（CGS）以预测不良麻醉事件中的恶性高热（MH）易感性。由于MH发作期间出现的许多临床症状是非特异性的，CGS被设计为一种估计MH定性可能性的工具。本研究的目的是比较CGS的结果与既定的体外挛缩试验（IVCT）的结果。
根据欧洲MH小组的方案，对92例有MH个人病史的患者进行IVCT检测MH易感性。所有患者也接受了CGS评估。CGS的临床指标包括强直、肌肉分解、呼吸性酸中毒、体温升高和心脏受累。如有MH家族史，则有额外指标。为每个指标加3至15分以得出原始分数；该原始分数对应于CGS中的MH等级，描述了疑似事件中MH的可能性。原始分数等级越高，MH的可能性越高，反之亦然。
92例患者中，32例（35%）经IVCT诊断为MH易感（MHS），47例（51%）为MH正常（MHN），13例（14%）为MH可疑（MHE）。CGS中MH等级为1（MH几乎从不发生）的1例患者被诊断为MHS；另一方面，CGS中MH等级为6（MH几乎确定）的患者无1例被诊断为MHN。然而，大多数患者（72%）被归为3级和4级（MH可能性略低/MH可能性略高）。因此，无法清楚地估计MH的定性可能性。
我们的研究表明，CGS的MH等级与IVCT的结果相关性较差。在任何情况下，对MH可疑事件的评估都取决于该事件数据的可用性。通常很难获得足够的数据，尤其是如果事件发生在很久以前。在这些情况下，MH等级可能低估了MH易感性的可能性。另一方面，也可能高估，因为一些评分指标仅取决于麻醉医生的判断。目前，CGS的使用既未经验证，在临床上也不可行。CGS不能替代IVCT。
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