【罂粟摘要】 无常备丹曲林时恶性高热的发生
无常备丹曲林时恶性高热的发生
贵州医科大学 高鸿教授课题组
翻译：张中伟 修改：吴学艳 编辑：佟睿 审校：曹莹
恶性高热是一种罕见但危及生命安全的药物源性肌肉疾病，其特征是异常高代谢反应；通常由挥发性麻醉剂和/或琥珀胆碱引发。不幸的是，丹曲林这种特效药，包括中国在内的许多国家并不作为常备药物。本研究目的是在丹曲林难以获得的情况下，找出恶性高热的特点。
对1985—2020年中国最常用数据库报道的恶性高热（MH）病例进行统计分析，纳入标准为仅与麻醉相关的MH发作；排除标准为由注射氯胺酮引起的可疑MH发作或与麻醉无关的MH发作。用独立样本t检验和皮尔逊卡方检验评估存活病例和死亡病例之间的差异。
选取1985—2020年我国最常用数据库报道的92例恶性高热病例进行分析，死亡病例的年龄中位数(IQR [范围])为18.5岁(11.8-37.0[0-70.0])，最大呼气末二氧化碳分压(P=0.033)、最大动脉二氧化碳分压(P=0.006)、首次发现异常时的体温(P=0.012)和最高体温(P<0.001)均高于存活病例。除此之外，死亡病例最低pH值较低(P < 0.001)，血钾较高(P < 0.001)，更易出现凝血功能紊乱(P=0.018)。在治疗方面，使用呋塞米(P = 0.024)、甘露醇(P = 0.029)、血液净化治疗(P = 0.017)对预后有明显优势。在第一周，磷酸肌酸激酶、肌红蛋白和磷酸肌酸激酶同工酶在不同病例间有很大差异。其中43例(46.7%)有先天性疾病，12例(13.0%)实验室检查结果异常或存在可能与麻醉相关的异常体征。
在丹曲林不易获得的国家，早期预防、诊断和做出及时有效的治疗对提高MH患者生存率至关重要。
Malignant hyperthermia when dantrolene
is not readily available
Abstract
Background: Malignant hyperthermia is a rare but life-threatening pharmacogenetic muscle disorder characterized by abnormal hypermetabolic reactions and commonly triggered in susceptible individuals by volatile anesthetics or succinylcholine, or both. Unfortunately, the specific medicine dantrolene is not readily available in many countries including China. The aim of this study was to find the characteristics of malignant hyperthermia under the situation that dantrolene is not readily available.
Methods: The cases of malignant hyperthermia reported on the most commonly used databases in China from 1985 to 2020 were analyzed. The inclusion criteria were the MH episodes only related to anesthesia. The exclusion criteria were dubious MH episodes only caused by Ketamine administration or MH episodes irrelevant to anesthesia. Independent samples t-test and Pearson’s chi-squared test were applied to assess the difference between the survived and death cases.
Results:Ninety-two cases of malignant hyperthermia reported on the most commonly used databases in China from 1985 to 2020 were analyzed. Median (IQR [range]) age was 18.5 (11.8–37.0 [0–70.0]) years. Compared with the survived cases, the death cases had higher maximum end-tidal partial pressure of CO2 (P = 0.033), the maximum arterial partial pressure of CO2 (P = 0.006), temperature first measured when the patient was first discovered abnormal (P = 0.012), and maximum temperature (P < 0.001). Besides, the death cases had less minimum pH (P < 0.001) and higher potassium (P < 0.001) and were more likely to have coagulation disorders (p = 0.018). Concerning treatment, cases used furosemide (P = 0.024), mannitol (P = 0.029), blood purification treatment (P = 0.017) had the advantage on the outcome. Creatine phosphokinase, myoglobin, and MB isoenzyme of creatine phosphokinase differed greatly among cases during the first week. 43 (46.7%) cases had congenital diseases. 12 (13.0%) cases were reported with abnormal laboratory test results or abnormal signs that are possibly relevant before anesthesia.
Conclusions: In countries that dantrolene is not readily available, early warning, diagnosis, and prompt effective therapies are crucial for MH patients to survive.
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翻译：张中伟
修改：吴学艳
编辑：佟睿
审校：曹莹