青少年脊柱侧凸患者后路矫形术中并发恶性高热的抢救与护理
摘要
报告3例青少年脊柱侧凸患者后路矫形术中并发恶性高热(Malignant hyperthermia,MH)的抢救与护理。护理重点包括:术前对MH的风险评估:对于发生MH的易感人群(如青少年脊柱侧凸畸形),护士术前应知晓挥发性麻醉剂和去极化肌松剂可触发MH。此外,对于脊柱畸形患者,护士应在矫形术前访视时进行MH风险评估;术中确立MH的预警机制;掌握术中出现MH时的应急处理:立即停用麻醉维持药物,更换麻醉回路,予以高流量纯氧过度通气;持续监测体温,积极降低体温;抗心律失常;维持水电解质平衡,保护心脑等重要脏器功能,保证循环稳定。
引文
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[2]Mc Carthy EJ.Malignant hyperthermia:pathophysiology,clinical presentation,and treatment.AACN Clin Issues,2004,15(2):231.
[3]Mathews KD,Moore SA.Multiminicore myopathy,central core disease,malignant hyperthermia susceptibility,and RYR1 mutations:one disease with many faces?Archives of Neurology,2004,61(1):27.
[4]Joshi M,Reddy BA,Bollampally B Joshi SD.Successful anaesthetic management of a patient with prior history of malignant hyperthermia for corrective scoliosis surgery.Indian J Anaesth,2014,58:78-80.
[5]L De Lamar.“Malignant hyperthermia”,in Alexander’s Care of the Patient in Surgery,12th ed,J Rothrock,ed(St Louis:Mosby,2003)247-249,1219.
[6]侯晓敏,丁红,冯茜.1倒全麻术中恶性高热患者成功救护的体会[J].护理学报,2010,17(6A):58-59.
[7]Rosenberg,et al.Malignant hyperthermia:a review[J].Orphanet Journal of Rare Disease,2015,10:93.
[8]张鸿敏,赵爱玲,杨秀芹,等.高热患者物理降温的护理进展[J].实用护理杂志,2001,17(8):47-48.
[9]徐桂花,朱丽莎,张玉琴.静脉输注低温加药液体对中枢性高热的降温效果及脑保护作用[J].护理研究,2013,27(6):1593-1594.
[2]Mc Carthy EJ.Malignant hyperthermia:pathophysiology,clinical presentation,and treatment.AACN Clin Issues,2004,15(2):231.
[3]Mathews KD,Moore SA.Multiminicore myopathy,central core disease,malignant hyperthermia susceptibility,and RYR1 mutations:one disease with many faces?Archives of Neurology,2004,61(1):27.
[4]Joshi M,Reddy BA,Bollampally B Joshi SD.Successful anaesthetic management of a patient with prior history of malignant hyperthermia for corrective scoliosis surgery.Indian J Anaesth,2014,58:78-80.
[5]L De Lamar.“Malignant hyperthermia”,in Alexander’s Care of the Patient in Surgery,12th ed,J Rothrock,ed(St Louis:Mosby,2003)247-249,1219.
[6]侯晓敏,丁红,冯茜.1倒全麻术中恶性高热患者成功救护的体会[J].护理学报,2010,17(6A):58-59.
[7]Rosenberg,et al.Malignant hyperthermia:a review[J].Orphanet Journal of Rare Disease,2015,10:93.
[8]张鸿敏,赵爱玲,杨秀芹,等.高热患者物理降温的护理进展[J].实用护理杂志,2001,17(8):47-48.
[9]徐桂花,朱丽莎,张玉琴.静脉输注低温加药液体对中枢性高热的降温效果及脑保护作用[J].护理研究,2013,27(6):1593-1594.