恶性高热3

Malignant HyperthermiaLecturer: guo chuanguowang mingA video:Definition: Malignant Hyperthermia (MH) is the only genetic disease that coursed by conventional anesthesia drugs during perioperate and can result in death. subclinical muscle disease Inhaling volatile anesthetics skeletal muscle tetanus contraction（ 强制收缩） the body temperature increase quickly the incidence rate in adult is 1/50,000,1/15,000 in children . In our country, 36 cases in total, death rate is 71.4%. Higher than that reported abroad(5-10%). Pathogenesis:volatile anesthetics CaERtetanus contractionmassive energylactic acid and COclinical symptomsTypical clinical symptoms: skeletal muscle rigidity suddenly hypercapnia 血碳酸过多症 temperature sharp rise, can reach to 45 46 ; How to diagnose MH? according to the typical clinical symptoms the relevant assay inspection (chemical examination)(mostly creatine phosphokinase (CPK ) 磷酸肌酸激酶 and myoglobin 肌红蛋白 ) rule out some other reasons that may cause the similar symptoms. Caffeine - halothane contracture test咖啡因 -氟烷离体骨骼肌收缩试验How to prevent?(1) Ask for the details of the medical history.(2) The CO2 and body temperature should be paid high attention to.(3) Do the caffeine halothane contracture test.Caffeine - halothane contracture testPeking Union Medical College Hospital Anesthesia Department咖啡因 -氟烷离体骨骼肌收缩试验Muscle biopsy (肌肉活检 ）Specific drug :Dantrolene (丹曲洛林 )Possible mechanism :Inhibiting the release of the calcium ion(Ca2+ ) in the sarcoplasmic reticulum (肌浆网 ) to make skeletal muscle relaxed.MH occurs, how to rescue?(1) Stop inhalation anesthesia ,give high flow oxygen and finish operation;(2) Cool the patients body;(3) Inject Dantrolene;(4) Monitor arterial blood pressure and the central venous pressure;(5) Deal with the complications.After rescue： Do caffe