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首页> 外文期刊>The Internet Journal of Emergency and Intensive Care Medicine >Two Survival Cases Of Severe Aconite Poisoning By Percutaneous Cardiopulmonary Support System And Cardiopulmonary Bypass For Fatal Arrhythmia: A Case Report
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Two Survival Cases Of Severe Aconite Poisoning By Percutaneous Cardiopulmonary Support System And Cardiopulmonary Bypass For Fatal Arrhythmia: A Case Report

机译：经皮心肺支持系统和心肺旁路治疗致命性心律失常导致严重附子中毒的两例生存病例报告

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Objective: to propose adequate treatment of fatal aconite poisoning using percutaneous cardiopulmonary support system and cardiopulmonary bypass.Design: case study.Setting: cardiac care unit in a university hospital.Patient: a 17-yr-old man ingested aconite roots to commit suicide and a 41-yr-old man eaten aconite tubers by accident.Intervention: immediate application of percutaneous cardiopulmonary support system and cardiopulmonary bypass for fatal arrhythmia caused by aconite.Measurements and main results: continuous ecg monitoring was performed. Concentrations of aconites in blood were measured by gas chromatography selected ion monitoring during institution of percutaneous cardiopulmonary support system and cardiopulmonary bypass. The changes of aconite concentration in blood showed that these concentrations are decreased under critical level 24 hours later from ingestion. At the same time fatal arrhythmias were also disappeared. The patients improved fatal arrhythmia and systemic circulation and discharged without neurological deficit.Conclusion: immediate application of percutaneous cardiopulmonary support system and cardiopulmonary bypass enable to survive fatal aconite poisoning patients. Introduction Aconite tubers are most toxic wild plants distributed from asia to western europe 1,2,3,4. It achieved some notoriety in the 19 th century as an agent for homicides and suicides. In modern times, aconite has been used as chinese herbal medicine, which are freely purchased from herb shop and consumed a doctation by herbal practitioner for pain control in northern hemisphere5. In japan, some cases of aconite poisoning appeared as result of committing suicide or accidental ingestion, mistaken for edible grass. However aconite alkaloids have potential of serious and even fatal cardiotoxity, which management has still remained difficult to save in patients with therapeutic resistant fatal arrhythmia 6,7.This report details two-survival cases of severe aconite-induced cardiotoxity using percutaneous cardiopulmonary support system (pcps and cardiopulmonary bypass) (cpb with changes of concentration of aconite alkaloids in blood and urine samples measured by gas chromatography selected ion monitoring 8. Case Reports Case 1A 17-year old man had roots of “toricabuto”, one of wild plant known as monkshood, which contains aconite alkaloids to commit suicide. Two hours later he begun nausea, vomiting and chest discomfort, and then he was transferred to hospital. At that time, ventricular tachycardia and ventricular fibrillation appeared with a rapid faint pulse, weak respiration, and loss of consciousness. Four and a half hours later, he was transported to our hospital by ambulance car. On admission, he was cardiac arrest and apnea so that he was immediately performed cardiopulmonary resuscitation (cpr, intubation and mechanical ventilation). After resuscitation, twelve-lead electrocardiogram showed multifocal tachycardia, torsade de pointes with rapid degeneration of ventricular fibrillation. Portable chest x-ray revealed no abnormality and laboratory examination revealed slight elevation of liver enzymes. Na, k and cl were 141.0, 4.6 and 106 meq/l respectively. Though intravenous infusion of several types of antiarrhythmics, such as lidocaine, mexiletine, magnesium, procaine and over thirty times of cardioversion had no effect of termination of such arrhythmia, forty minutes later from his admission he was performed percutaneous cardiopulmonary support system to maintain cerebral and visceral circulation. Hypothermic therapy of 32 degree of rectal temperature was also performed to prevent brain damage and organ function, and then he was transferred to cardiac care unit for intensive care. He was maintained at least 60mmhg of systolic blood pressure and 50ml/hour of urination. Five hours later from the application, he improved decreased appearance of ventricular fibrillation. Fifteen hours later, sinus rhythm was appeared and he rec
机译：目的：通过经皮心肺支持系统和体外循环，对致命的乌头中毒进行治疗。设计：案例研究地点：大学医院的心脏护理病房患者：一名17岁的男子食入乌头根自杀。一名41岁男子偶然吃了附子块茎。干预：立即应用经皮心肺支持系统和体外循环治疗附子引起的致命性心律失常。测量和主要结果：进行连续心电图监测。在建立经皮心肺支持系统和体外循环的过程中，通过气相色谱法选择离子监测仪测量了血液中附子的浓度。血液中附子浓度的变化表明，摄入后24小时，这些浓度在临界水平以下降低。同时致命的心律失常也消失了。患者改善了致命性心律失常和全身循环，出院时无神经功能缺损。结论：立即应用经皮心肺支持系统和体外循环可以使致命的附子中毒患者幸存。简介附子块茎是毒性最强的野生植物，分布于亚洲1,2,3,4至西欧。作为杀人和自杀的代理人，它在19世纪声名狼藉。在近代，附子已被用作中草药，可从草药商店免费购买，并由中草药从业人员服用以控制北半球的疼痛5。在日本，由于自杀或意外误食误认为食用草而导致乌头中毒。然而，附子生物碱具有严重甚至致命的心毒性，对于顽固性治疗性致命性心律失常的患者，仍然难以挽救这种病[6,7]。本报告详细介绍了两种经皮心肺支持系统存活的严重附子引起的心脏毒性（ pcps和体外循环）（cpb与通过气相色谱法测定的血液和尿液中附子生物碱浓度的变化选择了离子监测8）。病例报告病例1A的17岁男子有“ toricabuto”的根，这是一种野生植物，被称为附子中含有自杀生物的附子，两个小时后开始出现恶心，呕吐和胸部不适，随后被送往医院，当时出现室性心动过速和心室纤颤，脉搏快，呼吸弱，失去意识。四个半小时后，他被救护车运到我们医院。他患有心脏骤停和呼吸暂停，因此立即进行了心肺复苏（心肺复苏，插管和机械通气）。复苏后，十二导联心电图显示多灶性心动过速，尖端扭转型室性心动过速迅速变性。便携式胸部X光检查未见异常，实验室检查显示肝酶略有升高。 Na，k和cl分别为141.0、4.6和106meq / l。尽管静脉输注几种类型的抗心律失常药，如利多卡因，美西律，镁，普鲁卡因和超过30次的复律都没有终止这种心律失常的作用，但入院后40分钟，他进行了经皮心肺支持系统以维持脑和内脏循环。还进行了32度直肠温度的低温治疗以防止脑损伤和器官功能，然后将他转移到心脏监护病房进行重症监护。维持至少60mmhg的收缩压和50ml /小时的排尿时间。应用后五个小时，他改善了心室纤颤的外观。十五小时后，出现窦性心律，

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