乌头碱中毒致心律失常19例临床分析

Clinical analysis of 19 patients with arrhythmias caused by acute aconitine poisoning

目的 探讨乌头碱中毒的临床表现及治疗方法.方法 回顾性分析2010年至2012年乌头碱中毒致心律失常患者的临床表现及治疗方法资料.结果 共有19例患者,男性占79％,年龄49（34～62）岁,心电图均提示心律失常,其中显著窦性心动过缓3例：交界性逸搏心律1例,高度房室传导阻滞2例;室性心律失常13例：其中9例表现为单纯频发室性期前收缩,3例伴有室性心动过速,1例出现心室电风暴.所有患者均予以洗胃、补液,缓慢性心律失常患者予以阿托品、异丙肾上腺素治疗,其中阿托品静脉注射6例、异丙肾上腺素应用1例;室性心律失常者均予以硫酸镁静脉滴注、3例室性心动过速患者应用利多卡因治疗,反复心室颤动患者予以电击除颤及给予硫酸镁、利多卡因、胺碘酮等药物治疗.所有患者在24 h内均恢复窦性心律.结论 乌头碱中毒可以引发复杂多样的心律失常,严重者可以引发心室电风暴,早期诊断乌头碱中毒,及时识别心律失常、及时使用抗心律失常药物是抢救成功的关键.一旦心室电风暴发生,紧急电击除颤以及联合使用利多卡因、胺碘酮是提高抢救成功率的关键.

Objectives To explore the clinical characteristics and emergency treatment of patients with arrhythmias caused by acute aconitine poisoning. Methods We conducted a retrospective analysis during the period of 2010 to 2012. Clinical data of patients with arrhythmias caused by acute aconitine poisoning was analyzed. Results A total of 19 patients [male： 79% ; age： 49 （34-62） yearsl of acute aconitine poisoning were included. All the 19 cases had arrhythmias according to their electrocardiograms （ECGs）, including ： sinus bradycardia （heart rate 〈50 bit/min） （n = 3 ） ; junctional escape rhythm （n = 1 ） ; high degree atrioventrieular block （n =2） ; frequent ventricular extrasystoles （n = 9）; ventricular taehycardia （n=3） and ventricular electrical storm （n=l）. Ventricular arrhythmia was the most common type. All the cases accepted stomach lavage. Atropine or isoprenaline was given when bradyarrhythmia occurred. There were 6 cases receiving atropine and 1 case receiving isoprenaline. All the cases with ventricular arrhythmia received magnesium sulfate （n=13） ： 3 cases of ventricnlar tachycardia were treated with lidocaine; 1 patient with ventricular electrical storm accepted emergent electrical defibrillation for 6 times when ventricular fibrillation occurred, combined with lidocaine and amiodarone injection intravenously. All the 19 cases were cured and discharged from hospital in 24 h. Conclusions Acute aconitine poisoning can lead to various types of arrhythmias, including ventricular electrical storm. The key point of emergency treatment with arrhythmias caused by acute aconitine poisoning is its diagnosis in early stage and early use of antiarrhythmic drugs. When ventricular electrical storm occurs, emergent electrical defibrillation and combining use of lidocaine and amiodarone can increase the success rate.