台灣地區的醫院對惡性高熱病例的預防及治療措施調查

A Survey for Prevention and Treatment of Malignant Hyperthermia in Taiwan

背景：惡性高熱(malignant hyperthermia, MH)是一種高死亡率的罕見代謝性疾病，有先天性體質的病人接受全身麻醉時，由吸入性麻醉藥（halothane，isoflurane等）及去極化肌肉鬆弛劑(succinylcholine)所誘發，若處理太慢或不當，常會導致死亡，除了針對症狀治療外，靜脈注射dantrolene是一特殊療法，及早發現並採取適當的治療是降低死亡率的唯一方法，適當的監測可及早診斷、即時取得dantrolene可做適當的治療，對降低MH死亡率很有幫助，本研究即希望透過問卷調查的方式，了解台灣地區的醫院對此疾病的監測及治療能力。方法：針對台灣102間區域級以上的醫院做問卷調查，以瞭解台灣的醫院對此疾病的監測及處理能力。結果：發出問卷102份，回收66份，回收率64.7％。結果如下：(1)全身麻醉時succinylcholine的使用率，92.4％的醫院從偶爾使用至常規使用，其中使用頻率在70％以上的醫院有30家(45.5％)。(2)全身麻醉時，所有的醫院都常規使用pulse oximeter，而常規使用ETC02的醫院有51家(77.3％)，但常規持續監測體溫者只有13家(19.7％)。(3)備有dantrolene 6 vial以上的醫院只有23家(34.9％)，沒貯備dantrolene的醫院有43家，此43家醫院、其中的25家(58.1％)有特定可取得dantrolene的地方，當碰到MH病例時，平均需要70.7 ± 34.7分鐘（30～120分鐘）才能取得dantrolene。(4)在過去10年內，碰到過MH病例的醫院有17家(25.8％)，成功治療者15例，失敗者6例，因此死亡率為28.6％。結論：本研究顯示有些醫院的基本監測不足，且沒貯備dantrolene作不時之需，與歐美及日本比較、台灣MH病例的死亡率偏高。而降低MH死亡率的方法是及早診斷和盡快做適當的治療 建議醫院應重視基本的監測及貯備基本初劑量的dantrolene，以期能及早診斷和做適當的治療，以降低MH死亡率。

Background: Malignant hyperthermia (MH) is a hypermetabolic disorder with high mortality. Intravenous administration of dantrolene is the specific treatment. However, the only means to lower mortality rate are early detection and suitable treatment. Therefore, properly monitoring and handy availability of dantrolene are essential to lower the mortality of MH. This study was designed to evaluate the capabilities in prevention and treatment of MH of the hospitals in Taiwan. Methods: There were 102 certified training hospitals (including medical centers and regional hospitals) in Taiwan selected for this study. A questionnaire was designed to evaluate the capabilities of these hospitals in dealing with prevention and treatment of MH. Results: A total of 66 copies of the questionnaire were returned, which gave a response rate of 64.7%. The results of the survey are as follows: Succinylcholine was frequently used for induction in 92% of the hospitals investigated. For monitoring during general anesthesia, pulse oximeter was routinely used in 66(100%) hospitals, and ETCO2 monitor in 51 (77.3%) hospitals but continuous body temperature was routinely monitored only in 13 (19.7%) hospitals. Six or more vials of dantrolene were stored and available for immediate use in 23 (34.9%) hospitals and the rest of 43 (65.1%) hospitals did not have any stock of dantrolene at all. Of these 43 hospitals, 25 (58.1%) relied on other hospitals to supply dantrolene and the time required to obtain dantrolene from other hospitals was 70.7 ± 34.7 min. There were 21 cases who sustained MH in 17 (25.8%) hospitals in the past ten years, of whom 15 were resuscitated successfully and 6 died, thus giving a mortality rate of 28.6%. Conclusions: This study has revealed that in some hospitals in Taiwan intraoperatively (anesthetic) monitoring is inadequate and there is no stockpile of dantrolene for immediate treatment of MH. We recommend that appropriate anesthetic monitoring equipment should be strictly applied and a stock of initial dose of dantrolene (6 vials) should be kept, which are necessary for early diagnosis and treatment of MH.