Bawaskar H S, Bawaskar P H
J Assoc Physicians India. 2000 Dec;48(12):1175-80.
25-30% fatality due to acute pulmonary oedema in victims of Indian red scorpion (Mesobuthus tamulus) sting have been reported from Western Maharashtra, India. The advent of prazosin in recent years has revolutionized the management of severe scorpion sting cases. Majority of cases developed acute pulmonary oedema in 4-8 hours in a hospital setting irrespective of control of their arterial blood pressure with six hourly oral prazosin regimen, these cases recovered with extra dose of prazosin. We developed a standardised protocol for acute phase of treatment of these cases with the aim of preventing the development of pulmonary oedema.
We compared scorpion sting cases managed by non-protocol conventional (NPC) treatment and those by standardised protocol (SP) that included three hourly dose of oral prazosin. SP group included severe scorpion sting cases admitted to general hospital at Mahad in the year 1998 (Jan.-Dec.). While those admitted in the year 1997 (Jan.-Dec.) before the SP was implicated were the NPC group.
Characteristics on arrival of severe scorpion sting patients SP (n-17) and NPC (n-15) groups were similar that more case 6 (35%) from SP group had several hypertension on arrival. On arrival two cases from SP group and one from NPC group had pulmonary oedema. 16 (94.11%) patients from SP group recovered uneventfully, compared with 8 (53.33%) in NPC group (p-0.05). 0% Vs 5 (38.46%) developed acute pulmonary oedema (p < 0.0001) from SP and NPC group respectively, three (one had on arrival two patients during hospitalization) from NPC group had massive pulmonary oedema recovered with i.v. nitroprusside drip (SNP). While from SP group one had massive pulmonary oedema on arrival recovered with i.v. SNP, other one had pulmonary oedema recovered with oral prazosin. Cool extremities (vasoconstriction) persisted 11.5 (5-20) VS 18 (12-26) hours in SP and NPC group respectively.
Compared with NPC management; development of acute pulmonary oedema prevented by standardised protocol regimen at rural setting.
据印度马哈拉施特拉邦西部报告，印度红蝎子（印度杀人蝎）蜇伤受害者中，因急性肺水肿导致的死亡率为25%-30%。近年来哌唑嗪的出现彻底改变了严重蝎子蜇伤病例的治疗方式。大多数病例在医院环境中4-8小时内出现急性肺水肿，无论采用每六小时口服一次哌唑嗪的方案控制其动脉血压情况如何，这些病例通过额外剂量的哌唑嗪得以康复。我们制定了这些病例急性期治疗的标准化方案，目的是预防肺水肿的发生。
我们比较了采用非标准化常规（NPC）治疗和采用标准化方案（SP）（包括每三小时口服一次哌唑嗪）治疗的蝎子蜇伤病例。SP组包括1998年（1月至12月）在马哈德综合医院收治的严重蝎子蜇伤病例。而在标准化方案实施之前的1997年（1月至12月）收治的病例为NPC组。
严重蝎子蜇伤患者SP组（n = 17）和NPC组（n = 15）入院时的特征相似，SP组中更多病例6例（35%）入院时患有高血压。入院时，SP组有2例和NPC组有1例出现肺水肿。SP组16例（94.11%）患者顺利康复，而NPC组为8例（53.33%）（p = 0.05）。SP组和NPC组分别有0%和5例（38.46%）发生急性肺水肿（p < 0.0001），NPC组有3例（其中1例在住院期间有2名患者入院时出现）出现大量肺水肿，通过静脉注射硝普钠滴注（SNP）康复。而SP组有1例入院时出现大量肺水肿，通过静脉注射SNP康复，另1例肺水肿通过口服哌唑嗪康复。SP组和NPC组肢体发冷（血管收缩）分别持续11.5（5-20）小时和18（12-26）小时。
与NPC治疗相比，标准化方案在农村地区预防了急性肺水肿的发生。
