交感神经系统激活、抗蛇毒血清应用与蝎螫伤的心血管表现

Sympathetic nervous system activation, antivenin administration and cardiovascular manifestations of scorpion envenomation.

作者信息

Mazzei de Dàvila Carmen A, Dàvila Diego F, Donis Jose H, de Bellabarba Gabriela Arata, Villarreal Vanesa, Barboza Juan S

机构信息

Unidad de Cuidados Intensivos Pediátricos, Departamento de Fisiopatologi;a, Instituto de Investigaciones Cardiovasculares, Universidad de Los Andes, Aprartado Postal 590, Mérida 5101, Venezuela.

出版信息

Toxicon. 2002 Sep;40(9):1339-46. doi: 10.1016/s0041-0101(02)00145-9.

DOI:10.1016/s0041-0101(02)00145-9

PMID:12220720

Abstract

UNLABELLED

We performed two-dimensional echocardiograms and determined plasma norepinephrine levels on admission and at 24h after hospitalization, in 16 children with scorpion envenomation. All patients came from areas where scorpions have been identified as Tityus zulianus and received antivenin at the site of the accident or upon admission. Based on the presence or absence of cardiovascular manifestations, patients were divided into two groups.

GROUP A

10 patients had cardiovascular manifestations of pulmonary edema. Four patients had mild pulmonary edema (Left ventricular ejection fraction: 0.43+/-0.19) and six had moderate to severe pulmonary edema (Ejection fraction: 0.31+/-0.09. p=NS, M+/-SD). Plasma norepinephrine was elevated on admission (1279+/-824) and decreased at 24h in seven of eight patients (474+/-140 pg/ml, p<0.03).

GROUP B

Six patients had no cardiovascular manifestations. These patients had normal chest X-rays and normal echocardiograms. Plasma norepinephrine was not elevated (188+/-180 pg/ml). Time interval from the accident to antivenin administration was significantly longer in Group A compared to Group B (4.5+/-3.3 vs 1.2+/-0.4h, p<0.03) and correlated directly with the absolute change in plasma norepinephrine (r=0.76, p<001). Consequently, we strongly recommend very early administration of antivenin in the medical management of scorpion envenomation by T. zulianus.

摘要

未标注

我们对16例蝎子蜇伤儿童进行了二维超声心动图检查，并测定了入院时及住院24小时后的血浆去甲肾上腺素水平。所有患者均来自已鉴定为朱利尤斯肥尾蝎的地区，并在事故现场或入院时接受了抗蛇毒血清治疗。根据是否存在心血管表现，将患者分为两组。

A组：10例患者有肺水肿的心血管表现。4例患者有轻度肺水肿（左心室射血分数：0.43±0.19），6例有中度至重度肺水肿（射血分数：0.31±0.09。p=无显著性差异，均值±标准差）。8例患者中有7例入院时血浆去甲肾上腺素升高（1279±824），24小时时下降（474±140 pg/ml，p<0.03）。

B组：6例患者无心血管表现。这些患者胸部X光片和超声心动图均正常。血浆去甲肾上腺素未升高（188±180 pg/ml）。与B组相比，A组从事故到给予抗蛇毒血清的时间间隔显著更长（4.5±3.3 vs 1.2±0.4小时，p<0.03），且与血浆去甲肾上腺素的绝对变化直接相关（r=0.76，p<0.01）。因此，我们强烈建议在朱利尤斯肥尾蝎蜇伤的医疗处理中尽早给予抗蛇毒血清。