生物谷報(bào)道：惡性高熱癥(Malignant Hyperthermia,MH)是一種罕見的染色體顯性疾病,，患者在接觸某些麻醉藥物時(shí),，會(huì)發(fā)生危及生命的高代謝狀態(tài)。目前已經(jīng)知道惡性高熱癥與ryanodine受體基因(RYR1)缺陷有關(guān),。
患者可能于麻醉后數(shù)小時(shí)發(fā)病,。發(fā)病機(jī)制是肌漿網(wǎng)鈣離子的重?cái)z入減少，而重?cái)z入是終止肌肉收縮必不可少的,，由此引起肌肉的持續(xù)攣縮,，產(chǎn)生高代謝癥狀：代謝性酸中毒、心動(dòng)過速,、高碳酸血癥,、糖原分解、低氧血癥,、高熱,。某些病人可在發(fā)病前，多次接觸誘發(fā)疾病的藥物但卻不會(huì)發(fā)病,。典型的惡性高熱癥是由 succinylcholine(Sch) 或揮發(fā)性麻醉藥物所引起,。
DS是一種肌肉松弛劑，可以恢復(fù)患者體內(nèi)的鈣含量至健康的程度,，并減少高體溫,，防止患者因?yàn)槁樽韯┒劳觥８鶕?jù)一篇發(fā)表于4月號(hào)Journal of the American Association of Nurse Anesthetists中的報(bào)告指出,，將調(diào)配dantrolene sodium(DS) 的稀釋劑加熱,，可以使藥物發(fā)揮效果的速度增快。
研究人員發(fā)現(xiàn),，將DS 稀釋劑（滅菌水）加熱至攝氏41度可以安全地減少混合的時(shí)間并使患者的治療更快速,，爭取到三十秒以上的時(shí)間。而制備DS的過程,，通常需要二分鐘,。
(資料來源 : 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
