蝎蜇所致心肌毒性患者的临床及超声心动图表现

Clinical and echocardiographic findings in patients with myocardial toxicity due to scorpion sting.

作者信息

Rajasekhar D, Mohan A

机构信息

Sri Venkateswara Institute of Medical Sciences, Tirupati 517507, Andhra Pradesh, India.

出版信息

Natl Med J India. 2004 Nov-Dec;17(6):307-9.

PMID:15736551

Abstract

BACKGROUND

Myocardial toxicity following a sting by the Indian red scorpion (Mesobuthus tamulus) is a life-threatening medical emergency. A perusal of the published literature suggests that this problem has seldom been studied systematically.

METHODS

We retrospectively studied the clinical presentation and echocardiographic findings in 24 patients (mean [SD] age 23.2 [11.7] years; 19 males) with myocardial toxicity caused by the sting of an Indian red scorpion (Mesobuthus tamulus). They were treated with inotropic support and diuretics depending on the requirement. At admission, oral L-carnitine was administered in a dose of 1980 mg/day in three divided doses till the left ventricular (LV) function normalized. None of the patients received digitalis, prazosin, hydrocortisone or antivenin.

RESULTS

Extreme anxiety and severe pain at the site of sting were present in all the patients. Hypotension (n = 19), pulmonary oedema (n= 15) and acute renal failure (n=8) were the other presenting features. Chest X-ray revealed cardiomegaly in 8 and pulmonary oedema in 13 patients. Serum creatinine phosphokinase levels were elevated more than two times the upper limit of normal (200 IU/L) in 22 patients (92%). The mean duration of hospitalization was 5 days (range 3- 11 days). L-carnitine treatment resulted in significant reduction in the LV diameter (mm) in diastole (47.6 [6.2] v. 42 [6.1], p < 0.01) and systole (42 [7.1] v. 28.2 [4], p<0.001); end-diastolic volume (ml) (108.7 [31.9] v. 81 [26.7], p <0.01) and end-systolic volume (ml) (81.3 [30.9] v. 31.1 [10.7], p < 0.001); and significant improvement in the stroke volume (ml) 27.8 [13.2] v. 61.7 [6.2], p<0.001) and ejection fraction (%) (25.5 [12.8] v. 61.2 [6.5], p<0.001). All the patients responded well to treatment and none died.

CONCLUSION

Our initial observations suggest a potential benefit with additional oral L-carnitine treatment in patients with myocardial toxicity caused by scorpion sting presenting with hypotension and severe LV dysfunction. These findings merit further study.

摘要

背景

印度红蝎（中东金蝎）蜇伤后引发的心肌毒性是一种危及生命的医疗急症。查阅已发表的文献表明，这一问题很少得到系统研究。

方法

我们回顾性研究了24例因印度红蝎（中东金蝎）蜇伤导致心肌毒性的患者（平均[标准差]年龄23.2[11.7]岁；19例男性）的临床表现和超声心动图检查结果。根据需要，给予他们强心支持和利尿剂治疗。入院时，口服左旋肉碱，剂量为1980毫克/天，分三次服用，直至左心室（LV）功能恢复正常。所有患者均未接受洋地黄、哌唑嗪、氢化可的松或抗蛇毒血清治疗。

结果

所有患者蜇伤部位均出现极度焦虑和剧痛。其他表现包括低血压（19例）、肺水肿（15例）和急性肾衰竭（8例）。胸部X线检查显示8例患者心脏扩大，13例患者出现肺水肿。22例患者（92%）的血清肌酐磷酸激酶水平升高超过正常上限（200国际单位/升）两倍。平均住院时间为5天（范围3 - 11天）。左旋肉碱治疗使舒张末期左心室直径（毫米）显著减小（47.6[6.2]对42[6.1]，p < 0.01）和收缩末期左心室直径（42[7.1]对28.2[4]，p<0.001）；舒张末期容积（毫升）（108.7[31.9]对81[26.7]，p < 0.01）和收缩末期容积（毫升）（81.3[30.9]对31.1[10.7]，p < 0.001）；每搏输出量（毫升）显著改善（27.8[13.2]对61.7[6.2]，p<0.001）和射血分数（%）（25.5[12.8]对61.2[6.5]，p<0.001）。所有患者对治疗反应良好，无一死亡。