误用超量香加皮致缓慢性心律失常

Bradyarrhythmia induced by misuse of excessive Cortex Periplocae

1例41岁女性患者因三叉神经痛自服中药汤剂(含枸杞10 g、红参10 g、五加皮15 g)1次。约6 h后患者突然出现心慌,于睡眠中惊醒,伴头晕,血压95/63 mmHg(1 mmHg=0.133 kPa)。心电图示心房颤动、心室率45次/min。予升高血压、改善心肌代谢等对症治疗,症状无缓解。之后患者出现恶心、呕吐,心率下降至35次/min,血压下降至87/36 mmHg。再次行心电图检查示交界性逸搏心律、T波改变。给予心电监测,持续吸氧,多巴胺、多巴酚丁胺持续静脉泵入,以及极化液等对症支持治疗。治疗8 d后患者病情改善,心电图示窦性心律。患者将所服中药送至专业机构鉴定,发现其含香加皮成分,而原处方为五加皮,故考虑患者的心律失常为误服超剂量香加皮所致。

A 41-year-old female patient took decoction of Chinese medicine(containing 10 g of Fructus Lyci,10 g of Radix Ginseng Rubra,and 15 g of Cortex Acanthopanax Radicis)by herself due to trigeminal neuralgia.After about 6 hours of medication,the patient developed palpitate suddenly,woke up in sleep,accompanied by dizziness.Her blood pressure was 95/63 mmHg.The electrocardiogram showed atrial fibrllation,and ventricular rate was 45 beats/min.Symptomatic treatments such as elevation of hypertension and improvement of myocardial metabolism were given,but the patient's symptoms were not improved.After that,she developed nausea and vomiting,her heart rate decreased to 35 beats/min,and blood pressure decreased to 87/36 mmHg.Electrocardiogram showed junctional escape rhythm and T-wave change.Electrocardiogram monitoring and continuous oxygen inhalation,and symptomatic and supportive treatments such as continuous IV pumping of dopamine and dobutamine,and polarized solution were given.Eight days after treatment,the patient's condition was improved.Electrocardiogram showed sinus rhythm.The patient sent the traditional Chinese medicine to a professional institution for identification,and found that it contained Cortex Periplocae,while the original prescription was Cortex Acanthopanax Radicis.Therefore,it is considered that the patient's arrhythmia was caused by mistakenly use of excessive Cortex Periplocae.