草乌中毒伴严重心律失常1例

A case of aconitum kusnezoffii intoxication with severe arrhythmia

草乌为毛茛科中药,其毒性较强,给药剂量与中毒剂量相近,临床上常见因药量过大或使用不当而造成中毒事件。草乌中毒尚无特效解毒药,重度草乌中毒可致恶性心律失常甚至死亡。本文报道1例2021年1月邯郸市第一医院急诊医学科应用注射用盐酸尼非卡兰辅助救治的重度草乌中毒病例。患者出现室性心动过速、心室纤颤、阿斯综合征。常规治疗外,应用尼非卡兰负荷量25 mg静注,继续维持量0.4 mg/kg/h持续泵入7 h后患者未再发作心律失常,24 h后停用尼非卡兰亦未再复发。提示临床重度草乌中毒所致恶性心律失常可应用尼非卡兰进行控制,尼非卡兰是否优于常规抗心律失常药物,仍需更多临床应用资料的累积及验证。

Aconitum kusnezoffii is a traditional Chinese medicine of Ranunculaceae family.Its toxicity is relatively strong,and its dosage is similar to that of poisoning.In clinical practice,poisoning events are often caused by excessive dosage or improper use.There is no specific antidote for kusnezoff root poisoning.Severe kusnezoff root poisoning can cause malignant arrhythmia and even death.A case of severe kusnezoff monkshood poisoning was reported in January 2021,which was treated with nificaran hydrochloride for injection in the emergency medicine department of the First Hospital of Handan City.The patient developed ventricular tachycardia,ventricular fibrillation and AS syndrome.In addition to conventional treatment,the patient did not have arrhythmia again after intravenous injection of 25 mg of nifekalan load and continuous pumping of 0.4 mg/kg/h for 7 hours,and did not relapse after discontinuation of nifekalan 24 hours later.It is suggested that the malignant arrhythmia caused by clinical severe kusnezoff monkshood poisoning can be controlled by nifekalan.Whether nifekalan is superior to conventional antiarrhythmic drugs still needs more accumulation and verification of clinical application data.