Successful Management of Intraoperative Sevoflurane-induced Malignant Hyperthermia: A Case Report

手術中Sevoflurane引發惡性高溫之成功處理個案：病例報告

黃琬瑜(Wan-Yu Huang) ； 鄭仁坤(Jen-Kun Cheng) ； 陳應麟(Ying-Lun Chen) ； 楊承憲(Chen-Hsien Yang) ； 勞萱之(Hsuan-Chin Lao) ； 饒瑞泓(Ruey-Horng Rau) ； 張承圭(Cheng-Kuei Chang) ； 陳建全(Chien-Chuan Chen)

《中華民國急救加護醫學會雜誌》 16卷4期 (2005/12) Pp. 165-174

https://doi.org/10.30018/JECCM.200512.0005

摘要

惡性高溫(Malignant Hyperthermia)是一種可致命的體染色體顯性遺傳疾病，因為它的病情進展快速，而且難以診斷。它的發生機轉目前仍未完全了解，可能是基因變異導致骨骼肌細胞內控制鈣離子釋出的ryanodine受器功能失常。當病人被給子可誘發急性高溫的藥物，可能引起肌肉細胞內鈣離子的濃度增加，肌肉代謝率增加，而導致體溫異常持續升高和二氧化碳蓄積。若病情持續進展下去，而未用唯一解藥單挫林(dantrolene)，死亡率很高。我們報告一例開顱手術中成功處理sevoflurane引發之惡性高溫危機且於罕見的再出血緊急手術時妥善預防惡性高溫發生之個案。

關鍵字

惡性高熱 ； sevoflurane ； 單挫林 ； 手術中

並列摘要

Malignant hyperthermia (MH) is a life-threatening disease that develops rapidly and may be difficult to identify. The mechanism is not fully understood, but it is generally believed that MH is a disorder of the ryanodine receptor, the calcium-release channel of the sarcoplasmic reticulum. It is an anesthesia-related complication characterized by a hypermetabolic response of skeletal muscle, severe hyperthermia, and hypercarbia. The mortality rate is high if MH is not diagnosed immediately and treated with the only effective drug, dantrolene. We successfully treated a woman who developed MH during a craniotomy. When she subsequently required a repeat craniotomy because of bleeding, we were able to prevent a second episode of MH by using only intravenous anesthesia and a portable ventilator.

並列關鍵字

malignant hyperthermia ； sevoflurane ； dantrolene ； intraoperative