Tarasiuk Ariel, Menascu Shay, Sofer Shaul
Pediatric Intensive Care Unit, Division of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel.
Toxicon. 2003 Jul;42(1):73-7. doi: 10.1016/s0041-0101(03)00102-8.
We tested the hypothesis that fluid resuscitation combined with antivenom serotherapy given after injection of scorpion venom may increase cardiac output (CO) and blood pressure (BP) and prevent the decline in bicarbonate, pH and gastric perfusion. Seventeen anesthetized, mechanically ventilated dogs were given 0.1 mg/kg i.v. venom of the scorpion Leiurus quinquestriatus. The dogs were randomized into three groups: six dogs were given venom alone; three dogs were given 6 ml of antivenom 1 minute before venom injection; eight dogs were given 6 ml of antivenom and 20 ml/kg of synthetic colloid solution, 20 min after venom injection. Parameters reflecting respiratory and circulatory functions were determined at baseline and 120 min after venom injection. Scorpion venom caused a decrease in CO, BP, pH and HCO3-. Gastric mucosal perfusion was severely affected as assessed by mucosal pH (pHi) and the gradient between mucosal and arterial pCO2 (delta pCO2). Antivenom given before venom injection prevented all the effects induced by the venom. Antivenom and fluid given 20 min after venom injection caused a marked increase in CO and BP, but had no effect on pH and HCO3- decline (compared with venom alone). Gastric perfusion slightly improved as the increase in delta pCO2 was attenuated. The combination therapy of antivenom and fluid in this dog model is superior to the therapy of each of them alone. The marked and long-standing improvement of CO is promising and may suggest improvement in HCO3- and pH with time.
在注射蝎毒后进行液体复苏联合抗蛇毒血清疗法，可能会增加心输出量（CO）和血压（BP），并防止碳酸氢盐、pH值和胃灌注量下降。对17只麻醉、机械通气的犬静脉注射0.1mg/kg的以色列金蝎毒液。将这些犬随机分为三组：六只犬仅注射毒液；三只犬在注射毒液前1分钟注射6ml抗蛇毒血清；八只犬在注射毒液20分钟后注射6ml抗蛇毒血清和20ml/kg的合成胶体溶液。在基线和注射毒液120分钟后测定反映呼吸和循环功能的参数。蝎毒导致CO、BP、pH值和HCO3-下降。通过黏膜pH值（pHi）和黏膜与动脉pCO2之间的差值（δpCO2）评估，胃黏膜灌注受到严重影响。在注射毒液前给予抗蛇毒血清可防止毒液诱导的所有效应。在注射毒液20分钟后给予抗蛇毒血清和液体，可使CO和BP显著增加，但对pH值和HCO3-下降没有影响（与仅注射毒液相比）。随着δpCO2增加的减弱，胃灌注略有改善。在这个犬模型中，抗蛇毒血清和液体的联合治疗优于单独使用其中任何一种的治疗。CO的显著且长期改善很有前景，可能表明随着时间推移HCO3-和pH值会有所改善。
