日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Pediatric Cardiology and Cardiac Surgery 31(1-2): 64-67 (2015)
doi:10.9794/jspccs.31.64

症例報告Case Report

小児開心術症例の術後劇症悪性高熱症の1例A Case of Postoperative Fulminant Malignant Hyperthermia after Pediatric Cardiac Surgery

1聖マリアンナ医科大学心臓血管外科Department of Cardiovascular Surgery, St. Marianna University School of Medicine ◇ 〒216-8511 神奈川県川崎市宮前区菅生2-16-12-16-1 Sugao, Miyamae-ku, Kawasaki-shi, Kanagawa 216-8511, Japan

2聖マリアンナ医科大学小児科Department of Pediatric Cardiology, St. Marianna University School of Medicine ◇ 〒216-8511 神奈川県川崎市宮前区菅生2-16-12-16-1 Sugao, Miyamae-ku, Kawasaki-shi, Kanagawa 216-8511, Japan

受付日:2014年11月11日Received: November 11, 2014
受理日:2015年2月11日Accepted: February 11, 2015
発行日:2015年3月1日Published: March 1, 2015
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悪性高熱症は,揮発性吸入麻酔薬や脱分極性筋弛緩薬が誘因と考えられ,周術期における致命的合併症の一つとされている.我々は,最近小児開心術症例で術後劇症悪性高熱症を経験したので,文献的考察をふまえて報告する.症例は11ヶ月男児,診断は心室中隔欠損症,Down症候群である.生後21日,肺動脈絞扼術と動脈管結紮術を施行した.今回根治術として,心室中隔欠損パッチ閉鎖と肺動脈絞扼解除を施行した.術後より40度の高熱が持続したが,循環動態は安定していた.第2病日に急激に右心不全を呈し,胸骨開放で小康をえた.第3病日に42度まで体温が上昇しCPKなどの上昇が認められ悪性高熱症と高度に疑い,ダントロレンの投与を開始し,マットを使用して体温調節を行った.第4病日より解熱傾向となり,特に後遺症を残さず救命できた.悪性高熱は,麻酔中の最高体温と麻酔中体温上昇速度を指標に劇症型と亜型に分けられ,さらに麻酔後に症状が起こる術後型に分類されている.本症例は,術後劇症悪性高熱症と考えられた.術後悪性高熱は,現在でも死亡率が12.2%と高く,心臓手術後の周術期管理で注意が必要である.

Malignant hyperthermia has been described as a rare genetic hypermetabolic disorder of skeletal muscle that is triggered by exposure to certain inhalation anesthetics and depolarizing muscle relaxants. The incidence of malignant hyperthermia has declined with improvements in anesthesia in recent years, but it is still a lethal complication of cardiac surgery. We experienced a case of postoperative fulminant malignant hyperthermia after pediatric cardiac surgery. The patient was an 11-month-old boy with a ventricular septal defect (VSD) and Down syndrome. He previously had undergone pulmonary artery banding and ligation of the persistent ductus arteriosus on day 21 after birth due to respiratory distress. In the present treatment, he underwent closure of VSD and de-banding. The operation was performed uneventfully, but soon after surgery, his body temperature rose to as high as 40°C. Two days after surgery, desaturation and cardiac failure occurred with hypermetabolic disorders. We re-opened the sternum, and his condition recovered after this procedure. We diagnosed this condition as a fulminant type of postoperative malignant hyperthermia. Dantrolene sodium hydrate was infused, and strong cooling via a mat was applied. He recovered with no significant neurological damage. We should be aware of this lethal complication after cardiac surgery. This case reminded us that early diagnosis and quick treatment are most important.

Key words: malignant hyperthermia; postoperative; pediatric cardiac surgery; complication

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