药物不良反应杂志
藥物不良反應雜誌
약물불량반응잡지
ADVERSE DRUG REACTIONS JOURNAL
2015年
2期
159-160
,共2页
氟烷%琥珀胆碱%恶性高热
氟烷%琥珀膽堿%噁性高熱
불완%호박담감%악성고열
Halothane%Succinylcholine%Malignant hyperthermia
1例36岁男性患者全身麻醉下行肝血管瘤局部剜除术。术前体温36.0℃，心率71次／min，呼吸14次／min，血压120／82 mmHg（1 mmHg=0.133 kPa）。行1.5％氟烷吸入诱导麻醉，之后依次静脉给予咪达唑仑、艾司洛尔、丙泊酚、瑞芬太尼、氯化琥珀胆碱和维库溴铵。血管瘤顺利切除。手术进行至90 min时，患者突发高热，体温40.0℃，心率140次／min，血压96／52 mmHg。麻醉师考虑为氟烷联用氯化琥珀胆碱所致的恶性高热。立即停用氟烷，给予物理降温，纠正酸中毒、高血钾、心律失常，升压，利尿，保护肾功能，以及同步直流电复律等对症救治。抢救过程中患者先后出现室性心动过速、心律失常、心跳停止、体温高于42.0℃等临床表现。出现恶性高热后约3 h，患者终因抢救无效死亡。
1例36歲男性患者全身痳醉下行肝血管瘤跼部剜除術。術前體溫36.0℃，心率71次／min，呼吸14次／min，血壓120／82 mmHg（1 mmHg=0.133 kPa）。行1.5％氟烷吸入誘導痳醉，之後依次靜脈給予咪達唑崙、艾司洛爾、丙泊酚、瑞芬太尼、氯化琥珀膽堿和維庫溴銨。血管瘤順利切除。手術進行至90 min時，患者突髮高熱，體溫40.0℃，心率140次／min，血壓96／52 mmHg。痳醉師攷慮為氟烷聯用氯化琥珀膽堿所緻的噁性高熱。立即停用氟烷，給予物理降溫，糾正痠中毒、高血鉀、心律失常，升壓，利尿，保護腎功能，以及同步直流電複律等對癥救治。搶救過程中患者先後齣現室性心動過速、心律失常、心跳停止、體溫高于42.0℃等臨床錶現。齣現噁性高熱後約3 h，患者終因搶救無效死亡。
1례36세남성환자전신마취하행간혈관류국부완제술。술전체온36.0℃，심솔71차／min，호흡14차／min，혈압120／82 mmHg（1 mmHg=0.133 kPa）。행1.5％불완흡입유도마취，지후의차정맥급여미체서륜、애사락이、병박분、서분태니、록화호박담감화유고추안。혈관류순리절제。수술진행지90 min시，환자돌발고열，체온40.0℃，심솔140차／min，혈압96／52 mmHg。마취사고필위불완련용록화호박담감소치적악성고열。립즉정용불완，급여물리강온，규정산중독、고혈갑、심률실상，승압，이뇨，보호신공능，이급동보직류전복률등대증구치。창구과정중환자선후출현실성심동과속、심률실상、심도정지、체온고우42.0℃등림상표현。출현악성고열후약3 h，환자종인창구무효사망。
A 36-year-old male underwent local resection of hemangioma of liver under general anesthesia. Physical examination showed the following results:body temperature was 36. 0 ℃,heart rate 71 beats/min,breathing rate 14 breathes/min,blood pressure 120/82 mmHg. The patient received induced anesthesia with 1. 5% halothane. And then received intravenous administration of midazolam,esmolol, propofol,remifentanil,suxamethonium chloride,and vecuronium bromide,successively. The patient's hepatic hemangioma was resected smoothly. He developed high fever(40℃),his heart rate was 140 beats/min,blood pressure 96/52 mmHg 90 minutes later. The anaesthetist considered as malignant hyperthermia due to halothane combined succinylcholine chloride. Halothane was withdrawn immediately. He underwent comprehensive treatments immediately,including physical cooling;correcting acidosis,hyperkalemia,and arrhythmia;elevating blood pressure;diuresis,protection of renal function,and synchronous direct current cardioversion. The patient developed ventricular tachycardia, arrhythmia, cardiac arrest, and high temperature( >42 ℃),successively during the treatment. Finally,the patient died despite resuscitation attempts about 3 hours after malignant hyperthermia occurred.
