恶性高热与劳累性热病、劳累性横纹肌溶解有关联吗?  

Is there a link between malignant hyperthermia and exertional heat illness,exertional rhabdomyolysis?

作　　者：曹锡清 魏华锋 郭向阳[3] CAO Cathy;WEI Huafeng;GUO Xiangyang(Department of Anesthesiology,Medstar Washington Hospital Center,Washington DC 20010;Department of Anesthesiology and Critical Care,Hospital of the University of Pennsylvania,Pennsylvania 19104,USA;Department of Anesthesiology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]医星华盛顿中心医院麻醉科,美国华盛顿特区20010 [2]美国宾夕法尼亚大学医学院麻醉科,美国费城19104 [3]北京大学第三医院麻醉科,北京100191

出　　处：《麻醉安全与质控》2020年第6期327-335,共9页Perioperative Safety and Quality Assurance

摘　　要：临床观察和近年恶性高热(MH)的研究发现,一小部分曾经历过劳累性热病(EHI)或劳累性横纹肌溶解(ERM)的患者由于携带与导致MH相似的兰尼定受体1(RYR1)的突变而增加了手术中发生MH的危险性;有MH既往史或家族史的患者在高强度运动、马拉松或军队训练时也更易发生劳累性热休克(EHS)或/和ERM,也可能发展为清醒型或非麻醉诱导的MH综合征。本文通过介绍一系列的病例报道和近期MH与EHI、 ERM相关的研究,进一步强调术前病史采集和MH危险评估的必要性,呼吁储备静脉丹曲林,提高临床麻醉医生、急诊室、神经内科、家庭社区医生、重症监护医生和外科医生对MH的认知。最后阐述了MH专家针对清醒型MH的共识和防治指南。Clinical observation and recent research on malignant hyperthermia(MH)has demonstrated that a minority of patients with history of exertional heat illness(EHI)or exertional rhabdomyolysis(ERM)raise the risk of intraoperative MH,as a result of carrying the similar genetic defects on ryanodine receptor1(RYR1)which are known MH pathogenic mutations;conversely,previous MH victims or people with a clear MH family history also increase the risk of exertional heat stroke(EHS)or/and ERM while participating extreme sports,marathon races or military training exercise,possible further development of awake MH or in another description as non-anesthesia MH.This review introduces sporadic case reports and recent studies on the association among the three disorders,emphasizes the indispensable preoperative history collection and MH risk assessments to MH prevention and treatments,and advocates appropriate storage of intravenous dantrolene in healthcare facilities.It will improve the awareness of MH not only in anesthesia providers,but also among emergency medicine,neurology,primary care,critical care physicians and surgeons.Finally here discusses the current consensus among world MH experts and guidelines on MH prevention and treatment.

关 键 词：恶性高热 劳累性热病 劳累性横纹肌溶解 兰尼定受体1致病突变 静脉丹曲林 恶性高热专家共识 

分 类 号：R614[医药卫生—麻醉学]