小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 暴露于强效吸入麻醉剂和/或琥珀酰胆碱（琥珀胆碱）
- MH 易感
- 既往 MH 发作
- 阳性家族史
- 分钟通气量增加
- 人体核心温度升高
- 肌肉强直
其他诊断因素
- 心动过速
- 排尿量减少
- 运动出汗过多
- 肌肉痉挛
- 自发性严重肌肉强直
危险因素
- 暴露于强效吸入麻醉剂和/或琥珀酰胆碱（琥珀胆碱）
- MH 易感
- 既往 MH 发作
- 阳性家族史
- 劳累中暑
诊断性检查
首要检查
- 终止吸入麻醉
- 呼出的二氧化碳、耗氧量（吸入-呼出的氧气浓度差）
- 静脉血气分析
- 血清电解质
- 血清肌酐
- 静脉注射丹曲林的试验性治疗
- 肌酸激酶
- 尿液分析
- 尿肌红蛋白
- 血小板
- 凝血酶原时间
需考虑的检查
- 咖啡因氟烷挛缩试验（CHCT）
- 体外挛缩试验（IVCT）
- 基因检测
- 肌酶缺陷筛查
治疗流程
吸入性麻醉药诱发型
运动或热诱发型
撰稿人
作者
Christopher M. Edwards, MD
Assistant Professor
Department of Anesthesiology
University of Florida College of Medicine
Gainesville
FL
利益声明
CME volunteers for the Malignant Hyperthermia Association of the United States (MHAUS), including as a consultant for the malignant hyperthermia hotline. CME is co-author of a chapter on malignant hyperthermia in Fuhrman & Zimmerman’s Pediatric Critical Care, 6th ed., Elsevier.
Nikolaus Gravenstein, MD
Professor
Department of Anesthesiology
University of Florida College of Medicine
Gainesville
FL
利益声明
NG is medical adviser/consultant for LifeFlow (410 Medical) and Teleflex, and has received funding from Merck for delivering education lectures to Merck employees. NG is Medical Director of the North American Malignant Hyperthermia Registry.
鸣谢
Christopher M Edwards and Nikolaus Gravenstein would like to gratefully acknowledge Dr Barbara W. Brandom and Dr Lena Mayes, the previous contributors to this topic.
利益声明
LM declares that she has no competing interests. BWB has been reimbursed by the not-for-profit sponsor of the North American MH Registry (NAMHR), the Malignant Hyperthermia Association of the United States (MHAUS) for attending meetings related to the management of the NAMHR. For the past 16 years, BWB received grants from MHAUS to maintain the NAMHR. BWB was the unpaid director of the NAMHR, until Jul 2016. BWB has given lectures and prepared educational materials for her previous employer, the Department of Anesthesiology in the University of Pittsburgh. As of 1 July, 2016, BWB retired from that employment. BWB has published papers and prepared educational materials for MHAUS, with the help of other volunteers for MHAUS. BWB sponsored LM for an award granted by the American Society of Anesthesiologists. This award allowed LM to travel to several medical centers that were active in the diagnosis of MH, as well as to the NAMHR to improve her understanding of this syndrome. This is part of BWB's mentoring of younger anesthesiologists. BWB is also an author of a number of references cited in this topic.
同行评议者
Henry Rosenberg, MD
Director
Department of Medical Education and Clinical Research
Saint Barnabas Medical Center
Livingstone
NJ
利益声明
HR declares that he has no competing interests.
Philip Hopkins, MD
Professor of Anesthesia
University of Leeds
Academic Unit of Anesthesia
St James's University Hospital
Leeds
UK
利益声明
PH is an author of a number of references cited in this topic.
Thierry Girard, MD
Associate Professor
Perioperative Patient Safety
Department of Biomedicine
University Hospital Basel
Basel
Switzerland
利益声明
TG declares that he has no competing interests.
Joseph Tobin, MD, FAAP, FCCM
Professor and Chairman
Department of Anesthesiology
Wake Forest University School of Medicine
Winston-Salem
NC
利益声明
JT is an author of a number of references cited in this topic.
鉴别诊断
- 非 MH 横纹肌溶解症
- 肌肉废用性萎缩
- 肌强直
更多 鉴别诊断指南
- 恶性高热 2020
- 欧洲恶性高热研究组关于恶性高热疑似或易感患者围手术期管理的共识指南
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