43例急性乌头碱中毒的心电图及临床检验分析

Characteristics and significances of ECG and clinical laboratory examination results in 43 patients with acute aconitine poisoning

目的探讨急性乌头碱中毒致心律失常病例的心电图和实验室检查特点。方法对43例急性乌头碱中毒病例进行分析,总结其临床表现、心电图改变、实验室检查及救治要点。结果 43例患者均发生心律失常,室性期前收缩最为多见。恶性心律失常均出现在临床重度中毒患者中。其中2例重度中毒患者行急诊床旁血液灌注联合血液透析治疗,临床效果较好。中度和重度中毒患者均出现心肌酶谱升高,血清K+、Mg2+浓度降低。所有患者经积极治疗后心电图、心肌酶谱、电解质恢复正常,均治愈出院。结论乌头碱中毒所致心肌损害程度与血浆毒性成分浓度呈正相关,心电图表现多样化,严重者出现致命性的严重心律失常。积极对症支持治疗,早期及时应用抗胆碱能药物,根据心律失常类型选用抗心律失常药物,重度中毒患者采用床旁血液灌注联合血液透析治疗可迅速纠正心律失常,提高抢救成功率。

Objective To study the characteristics and significances of electrocardiogram（ECG）in the patients with acute aconi-tine poisoning.Methods Collected and analysed the data of 43 aconitine poisoning patients,summarize their clinic feature,ECG changes,laboratory test and treatment methords.Results All 43 cases showed arrhythmia under their ECGs,most of which were ventricular premature beats.Frequent multifocal ventricular arrhythmia,torsade de pointes,ventricular fibrillation occurred in severe aconitine poisoning patients.2 severe cases were treated with blood perfusion and purification in emergency and their arrhythmias were corrected rapidly.Serum K＋ ,Mg2 ＋ coucentrations decreased while myocardial enzymes increased in patients with severe and moderate poisoning.After active treatment,the ECG,cardiac creatase and electrolytes in all cases turned to normal.All 43 patients were cured.Conclusion The study shows the diversity of arrhythmia in acute aconitine poisoning patients and the deadly arrhyth-mia occurred in severe patients.Actively support therapy,early use of anticholinergic and antiarrhythmic drug,blood perfusion and purification in severe poisoning patients can rapidly cure arrhythmia and improve the rescue success rate.