生物谷报道：恶性高热症(Malignant Hyperthermia,MH)是一种罕见的染色体显性疾病，患者在接触某些麻醉药物时，会发生危及生命的高代谢状态。目前已经知道恶性高热症与ryanodine受体基因(RYR1)缺陷有关。
患者可能于麻醉后数小时发病。发病机制是肌浆网钙离子的重摄入减少，而重摄入是终止肌肉收缩必不可少的，由此引起肌肉的持续挛缩，产生高代谢症状：代谢性酸中毒、心动过速、高碳酸血症、糖原分解、低氧血症、高热。某些病人可在发病前，多次接触诱发疾病的药物但却不会发病。典型的恶性高热症是由 succinylcholine(Sch) 或挥发性麻醉药物所引起。
DS是一种肌肉松弛剂，可以恢复患者体内的钙含量至健康的程度，并减少高体温，防止患者因为麻醉剂而死亡。根据一篇发表于4月号Journal of the American Association of Nurse Anesthetists中的报告指出，将调配dantrolene sodium(DS) 的稀释剂加热，可以使药物发挥效果的速度增快。
研究人员发现，将DS 稀释剂（灭菌水）加热至摄氏41度可以安全地减少混合的时间并使患者的治疗更快速，争取到三十秒以上的时间。而制备DS的过程，通常需要二分钟。
(资料来源 : Bio.com)
英文原文：
Research Reveals Way to Speed Up Treatment
05/08/07 -- Every second counts for anesthesia patients afflicted by the often deadly condition known as malignant hyperthermia (MH). According to research published in the April AANA Journal of the American Association of Nurse Anesthetists, the intravenous administration of life-saving dantrolene sodium (DS) can occur significantly faster thanks to a new method of warming the diluent that is used to prepare the DS for use.
Malignant hyperthermia is a silent, inherited metabolic disorder of the muscle that is triggered by specific inhaled anesthetics or succinylcholine and can result in a severely high body temperature. Affected individuals usually appear normal and have no functional difficulties in everyday life. However, when these individuals receive anesthesia for surgery or some other procedure, this silent disorder can turn deadly. Treatment with DS, a muscle relaxant that restores a healthy level of calcium in the muscles and reduces high body temperature, prevents mortality when administered properly.
The study, titled "The Icarus Effect: The Influence of Diluent Warming on Dantrolene Sodium Mixing Time," set out to determine the possibility of a more expedient method of warming the diluent in order to mix it with DS, thus saving precious time between the onset of MH and the administration of DS. It was conducted by Kevin Baker, CRNA, MSNA, staff nurse anesthetist for West End Anesthesia Group at St. Mary's Hospital in Richmond, Va.; Donna Landriscina, CRNA, MSNA, assistant professor and assistant director of education in the Department of Nurse Anesthesia, Virginia Commonwealth University, and staff nurse anesthetist at Virginia Commonwealth University (VCU), Medical Center in Richmond, Va.; Heather Kartcher, RN, BSN, a second year graduate student in the Department of Nurse Anesthesia at VCU; and David Mirkes, RN, BSN, a second year graduate student in the Department of Nurse Anesthesia at VCU.
The researchers discovered that by warming the DS diluent (sterile water) to 41 degrees Celsius it safely lessoned the mixing time and resulted in faster treatment of patients suffering from MH. Thirty seconds or more could be shaved off the DS preparation process, which normally takes two minutes. To conduct the study, two standard fluid warmers were used that are typically found in hospital rooms around the country.
"Every second counts when treating a patient with malignant hyperthermia," said Donna Landriscina, CRNA, MSNA. "This research indicates that it is possible to administer DS faster, thereby increasing the patient's chances of a successful outcome."
The diagnosis of malignant hyperthermia in a patient requires swift action on the part of the anesthesia provider. The key to effectively controlling an MH crisis is the quick administration of DS. Since its introduction into clinical practice in 1979, DS continues to be the first-line of defense against reducing the MH mortality rate from nearly 80 percent in the 1970s to less than 10 percent today.
"For years, nurse anesthetists have been on the forefront of research that has greatly enhanced anesthesia safety," said Kevin Baker, CRNA, MSNA. "New discoveries of best practices such as this one will benefit patients for decades to come."
Source: American Association of Nurse Anesthetists
