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論文名稱(外文):The pathophysiological responses induced by sevoflurane and halothane in acute porcine malignant hyperthermia model
外文關鍵詞:malignant hyperthermiacalcium ionskeletal muscle
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惡性高溫症(MH)是一種經麻醉劑和藥物引發骨骼肌內鈣離子調控異常,會危及生命的高代謝狀況徵候。本實驗以惡性高溫的動物模式來評估由sevoflurane和halothane所誘發的惡性高溫反應中,動物體溫和生理性變化及其與臨床的徵候相關性。共有十五頭純種豬,經由突變點拆離式聚合酶連鎖反應(MS-PCR)證實的緊迫豬,體重12至35公斤被選用,並以ketamine、azaperone和thiopental 肌肉麻醉,且維持在接近其正常體溫(接近38.5℃)。經過30分之穩定呼吸期後,開啟吸入性氣體麻醉劑sevoflurane(第一組,n=9)或halothane(第二組,n=6),並用固定和增加濃度的方式給予。在給予期間監視吐氣末二氧化碳分壓濃度(ETCO2),心血管功能,中心溫度(食道,直腸)和骨骼肌細胞懸浮液之胞內鈣離子。在曝露於吸入性麻醉劑之後,很短時間內所有動物都會有急性惡性高溫反應,我們持續記錄此種病理生理反應直到動物死亡。然後以迴歸分析方式來分析和預測此病理生理狀況找出適合之公式。以下為找出有顯著意義的因素:ETCO2、舒張壓(DBP)、肛溫(Tana)和麻醉劑累積劑量(DOSECUM)。經麻醉劑刺激後溫度上昇和動物死亡所需的時間在sevoflurane都較短。本動物模式的預測對使用sevoflurane於小兒麻醉的手術室上,能因而建立兒科麻醉的一種警訊系統。
Malignant hyperthermia (MH) is an anesthetic-drug-induced, life-threatening hypermetabolic syndrome caused by abnormal calcium regulation in skeletal muscle. This study was designed with animal model of MH to evaluate how physiological changes and temperature correlate with clinical sign of a MH episode by sevoflurane and halothane. Fifteen purebred susceptible pig, confirmed by mutagenically separated polymerase chain reaction (MS-PCR), weighing 12~35Kg were used and anesthetized with ketamine, azaperone and thiopental, and kept at normothermic (≒38.5℃)status. After a 30-min control period, sevofurane (group 1, n=9) or halothane ( group 2, n=6) was administered to the pigs with fixed or increased concentration respectively. Monitoring measurements included: 1) End-tidal CO2 (ETCO2); 2) Cardiovascular function; 3) Core temperatures (esophagus, rectum); and 4) Skeletal muscle cell suspension for intracellular Ca2+. All animals developed fulminant MH within very shot time after exposure to inhalation anesthetics. Recording on the pathophysiological changes was continued until animals expired. A regression model analysis was employed for the analyses and the most suitable formulae for prediction the pathophysiological condition in a MH episode were determined. The following findings were determined to be the most significant: ETCO2, diastolic blood pressure (DBP), rectum temperature (Tana) and accumulated dose of anesthetics (DOSECUM). The time elapsed to temperature increase and animal death were all shorter in sevoflurane group. The prediction of this animal model could be applied in establishing a warning system when the use of sevoflurane at the operation room, especially in peadiatric patients, was performed.
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