七氟醚延长长QT综合征3型患者的QTc间期及增加跨室壁复极离散度：病例报告
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Sevoflurane prolonged the QTc interval and increased transmural dispersion of repolarization in a patient with long QT syndrome 3: a case report
背景与目的
先天性长QT综合征（LQTS）是一种以心电图（ECG）上QT间期延长为特征的遗传性疾病，可导致致死性心律失常，如尖端扭转型室速（TdP）、室颤（VF）和心源性猝死。迄今为止，据报道至少有15种不同的基因与LQTS相关。
方 法
我们报道了七氟醚不仅可引起长QT综合征3型(LQT3)患者的QTc间期延长，还可增加跨室壁复极离散度。一名16岁的LQT3男性患者接受肩部手术，未发生晕厥、心跳骤停，但术前心电图（ECG）显示明显的QTc间期延长（631ms）及Tp-e间期延长（126ms）。麻醉采用丙泊酚诱导，2%七氟醚和瑞芬太尼维持。
结 果
尽管围手术期没有发生致死性心律失常，但七氟醚不仅可以延长QTc间期，而且还可以延长Tp-e间期。尽管认为七氟醚在QT间期延长方面是一种安全的麻醉药，但对长QT综合征患者，我们认为对于控制不良的LQT3型患者应避免使用七氟醚。
结 论
七氟醚仍是适用于长QT综合症患者的一种安全的麻醉药，但对于QTc和/或Tp-e间期延长的LQT3患者还是存在致TdP和致死性心律失常的风险。
原始文献摘要
Kitaura A, Nakao S, Hamasaki S, et al. Sevoflurane prolonged the QTc interval and increased transmural dispersion of repolarization in a patient with long QT syndrome 3: a case report:[J]. Ja Clinical Reports, 2017, 3(1):29.
Abstract:We report that sevoflurane not only caused marked QTc interval prolongation but also increased transmural dispersion of repolarization in a patient with long QT syndrome 3 (LQT3). A 16-year-old male with LQT3 underwent a shoulder operation. He experienced no episode of syncope or cardiac arrest, but his preoperative electrocardiography (ECG) showed marked QTc interval prolongation (631 ms) and Tp-e interval prolongation (126 ms). Anesthesia was induced with propofol and maintained with 2% sevoflurane and remifentanil. Although no lethal arrhythmias occurred in the perioperative period, not only the QTc interval but also Tp-e interval was further prolonged by sevoflurane. While sevoflurane has been recognized as a safe anesthetic in terms of QT interval prolongation, even in patients with long QT syndromes, we believe that sevoflurane might be avoided for poorly controlled LQT3 patients.
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