口腔手术中恶性高热患儿的救护

Rescue of a child with malignant hyperthermia during oral surgery

恶性高热(MH)是全身麻醉期间发生的一种进行性危及生命的高热症状[1]。MH有潜在的遗传基础,遗传易感个体在全身麻醉期间接触吸入麻醉剂或去极化肌松药后出现骨骼肌强直性收缩,产生大量能量,故导致体温持续升高[2-3]。临床表现为各种恶性高代谢综合征,包括体温急剧升高、高碳酸血症、心动过速和呼吸性酸中毒、高钾血症,以及由此引起的心律失常或停搏,最终导致多器官功能衰竭,甚至病死[4-5]。在口腔临床诊疗过程中,随着全麻手术的推广,发生MH的风险也逐步增大。现报道1例于我院就诊,在口腔术中发生MH的患儿,经积极抢救,痊愈出院。

During general anesthesia,malignant hyperpyrexia(MH)is a progressive life-threatening hyperpyrexia symptom[1].MH has an underlying genetic basis.The genetically susceptible individuals experience tonic contractions of skeletal muscle after exposure to inhaled anesthetics or depolarizing muscle relaxants during general anesthesia,producing large amounts of energy,resulting in a sustained increase in body temperature[2-3].The clinical manifestations are various malignant hypermetabolism syndromes,including arapid increase in body temperature,hypercapnia,tachycardia,and respiratory acidosis,hyperkalemia,and the resulting arrhythmia or arrest,eventually leading to multiple organ failure and even death[4-5].In oral clinical treatment,the risk of MH has gradually increased with the promotion of general anesthesia surgery.A case of a child with MH seen in our hospital during oral surgery was actively rescued and discharged from the hospital.