隨著特效藥物進入臨床使用，惡性高熱的死亡率已降至2%至3%左右。

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日前，一名中年男性患者在上海市公共衛生臨床中心接受骨科手術時，術中突發惡性高熱，情況十分危急。在麻醉科主任王利的指揮下，麻醉醫護團隊默契配合，經過4個多小時的全力救治，患者最終轉危為安。

該患者正值壯年，原本以為只是一臺常規外科手術，不想術中出現了突發危急狀況——心率驟增，短時間內超過了140次/分鐘，隨之監護儀顯示患者呼氣末二氧化碳分壓已超過110毫米汞柱，同時血壓驟降。

經過快速鑒別排查，王利發現患者體溫已接近40度，臨床診斷指向了最兇險的術中麻醉危象——惡性高熱。這是一種常染色體顯性遺傳疾病，通常由吸入性麻醉藥物及去極化肌肉松弛劑誘發，臨床表現為體溫急劇升高、心動過速、心律失常、低血壓等，患者常在短時間內因多器官功能衰竭導致死亡。一旦發病，極其兇險，搶救窗口期極短。

時間就是生命，全體在院的麻醉科醫護全員到位。他們各司其職：管理呼吸、開放中心靜脈通道、建立高級血流動力學監測、實施全身降溫、檢測生化及內環境指標、升壓糾酸降鉀。

在實施急救的同時，市公衛中心立即向兄弟醫院申請調用惡性高熱的特效急救藥物——丹曲林鈉。隨著藥物緩慢注入患者體內，兇險的惡性高熱被徹底制服。當晚9時許，患者轉危為安，送往重癥監護室后續觀察治療。第二天，患者意識完全清醒，生命體征平穩，順利脫機拔管，未發生任何不良后果。

據醫生介紹，惡性高熱是全球麻醉界談之色變的致命麻醉并發癥，極為罕見但致死率極高。作為一種基因遺傳性代謝異常綜合征，該病發病率僅約五萬分之一。患者平時無異常表現，一旦誘發將出現持續性肌肉代謝亢進，產熱急劇增加，核心體溫急劇升高和重度酸中毒。

患者體溫可迅速升至42℃以上且常規降溫措施無效，同時產生大量乳酸和二氧化碳；病情惡性發展，出現嚴重酸中毒、低氧血癥、高血鉀和心律失常等一系列變化，最終死于多器官功能衰竭。

大多數病例與RYR1基因突變有關，當存在這種基因缺陷時，患者暴露于某些誘發藥物下，會觸發細胞內鈣離子濃度失控性增加，導致肌肉纖維持續興奮并產熱。隨著特效藥物進入臨床使用，惡性高熱的死亡率已降至2%至3%左右。

目前對于惡性高熱易感人群已有了針對性較強的基因篩查技術，可以及時做出術前診斷，若家中曾有親人在接受麻醉過程中出現不明原因意外高熱，也可提前告知麻醉醫生，以便其更好地選擇麻醉方法及麻醉藥物，保證患者的麻醉安全。