Menzel H, Gullotta F, Helpap B, Freiberger K
Prakt Anaesth. 1976 Aug;10(4):227-35.
Two cases of malignant hyperthermia with different clinical courses are reported. The patients showed the classical signs of malignant hyperthermia consisting of tachycardia, tachypnoea, ocasional peripheral cyanosis, high body temperature as well as characteristic rise in serum enzymes. In one of the patients the symptoms were recognized early during the operation. The immediate commencement of therapy with ice-cooled. Ringer-Lactate-Solution, Procainmedication, Corticoids as well as physical body cooling favourably influenced the clinical course and the patient survived. In both cases the patients underwent succinylcholine and halothane anaesthesia, but the symptoms of the second patient appeared after the reduction of anaesthesia. In spite of vigorous therapy the hyperpyrexia resulted in heart arrest and death. Morphologically, both patients showed signs of preexistent myopathy with volumetric alterations of the muscle fibres, centralisation of the nuclei and acute muscle fibre necrosis. On the basis of the observed variable course, the various symptom complexes reported in the literature to data are reviewed. A detailed discussion of the "carrier problem" and the available treatment possibilities is also made. Realising that malignant hyperthermia is an inheritable disease, prophylactic measures such as, f.i. the issue of medical certificates to the patient and his relatives are suggested.
报告了两例临床病程不同的恶性高热病例。患者表现出恶性高热的典型体征，包括心动过速、呼吸急促、偶尔的外周发绀、高热以及血清酶特征性升高。其中一名患者在手术过程中早期就被识别出症状。立即开始用冰冷却的乳酸林格氏液、普鲁卡因药物、皮质类固醇进行治疗以及对身体进行物理降温，对临床病程产生了有利影响，患者存活下来。两例患者均接受了琥珀酰胆碱和氟烷麻醉，但第二例患者的症状在麻醉减浅后出现。尽管进行了积极治疗，高热仍导致心脏骤停和死亡。形态学上，两名患者均显示出存在先前肌病的迹象，表现为肌纤维体积改变、核中央化和急性肌纤维坏死。基于观察到的不同病程，对文献中迄今报道的各种症状组合进行了综述。还对“携带者问题”和可用的治疗可能性进行了详细讨论。认识到恶性高热是一种遗传性疾病，建议采取预防措施，如向患者及其亲属发放医疗证明等。
