Studies on the Prophylaxis, the Diagnosis and the Treatment of Malignant Hyperthermia

<Studies with the Skinned Fiber Technique>在恶性高热患者中，肌浆网（SR）的Ca^&lt;2 +&gt;诱导的Ca ^&lt;2+&gt;释放（CICR）速率似乎在遗传上异常增强，这种异常是用皮肤纤维技术观察到的。因此，我们采用皮肤纤维技术研究了围手术期药物对人骨骼肌CICR的影响及CICR的速率。1）在哺乳动物体温下，临床浓度的所有挥发性麻醉药均能加速人骨骼肌CICR速率。所有局麻药在临床浓度下均不影响CICR率，但根据其在高于临床浓度约1000倍时对CICR率的影响，将局麻药分为CICR促进剂（利多卡因、甲哌卡因、布比卡因、丙胺卡因）和CICR抑制剂（普鲁卡因、丁卡因）两组。去极化和非去极化肌松药对CICR无影响，麻醉药对CICR无影响。 ...更多信息 2）为确定正常人骨骼肌CICR率的标准值，采用皮肤纤维技术测定了28例正常人骨骼肌CICR率。不同性别、年龄组间无显著性差异。3<plus-minus>）对116例疑似MH患者进行CICR检测。18例暴发型MH中16例CICR率增高，27例流产型MH中25例CICR率在正常范围内。<Statistical review of fulminant malignant hyperthermea in Japan>本文收集了日本1961 ~ 1990年报告的暴发性MH病例，进行回顾性分析，共收集到252例，其中男性196例，女性56例，死亡率为34.9%。最高体温在40 ℃以上者病死率为46.2%，低于40 ℃者病死率为4.4%。近年来（1986-1990年）死亡率下降到13.0%，安氟醚麻醉病例增多。<Various incidences of fulminant malignant hyperthermia in Japan>1976 ~ 1987年共收治全身麻醉病人890万例，其中暴发性MH 140例。平均发病率为1/64000，男性发病率是女性的3.6倍，根据全身麻醉的年龄分布和暴发性MH病例数，计算出20岁男性暴发性MH发病率最高（1：11,000）。少

<Studies with the Skinned Fiber Technique> In malignant hyperthermia patients, the rate of Ca^<2+>-induced Ca^<2+> release (CICR) from the sarcoplasmic reticulum (SR) seems to be abnormally potentiated in genetic.This abnormality is observed with the skinned fiber technique. So we studied the effects of drugs used perioperatively on CICR and the rate of CICR of human skeletal muscle with the skinned fiber technique.1) All volatile anesthetics in clinical concentration accelarated the rate of CICR at the mammalian temperature. All local anesthetics in clinical concentration didn't affect the rate of CICR, but according to their effects on the rate of CICR in about one thousand times higher concentration than clinical, the cocal anesthetic were divided into two groups ; CICR accelerators (lidocaime, mepivacaine, bupivacaine, prilocain) and CICR inhibitors (procaine, tetracaine). Muscle relaxants (depolarizing and non-depolarizing) didn't affected the rate of CICR, and all narcotics didn' … More t too.2) In order to determine the standard value of the rate of CICR in human skeletal muscle, in normal 28 volunteers the rates of CICR were measured by skinned fiber technique. No significant difference couldn't be observed by sex and age. So we determined the value of mean<plus-minus>2SD as the normal rang3) The rate of CICR of 116 patients suspected MH were measured. In 16 cases out of 18 fulminant MH cases the rate of CICR potentieted, but in 25 cases out of 27 abortive MH within normal range.<Statistical review of fulminant malignant hyperthermea in Japan>We collected fulminant MH cases reported from 1961 to 1990 in Japan and analyzed them retrospectively.Total number of fulminant MH cases that we could collect were 252, 196 in male and 56 in female.Mortality rate was 34.9%. The mortality rate in patients whose maximum body temperature above 40^ﾟC was 46.2%, but that below 40^ﾟC was 4.4%. The mortality in dantloren-treated patients was lower than one in dantloren-no-treated.In recent years (1986-1990), the mortality decreased to 13.0% and the cases anesthetized by enflurane increased.<Various incidences of fulminant malignant hyperthermia in Japan>The total number of general anesthesias from 1976 to 1987 was 8,900,000 and 140 cases of fulminant MH were reported for the same period. The average incidence was 1 out of 64,000 general anesthesias.The incidence of male MH was 3.6 times greater than that of female MH.Based on the age distribution of general anesthesia and the number of fulminant MH cases, the calculated incidence of fulminant MH was proved to be highest in male twenties (1 : 11,000). Less