Gueron M, Ilia R, Sofer S
Division of Cardiology, Soroka University Hospital, Faculty of Health Science, Ben-Gurion University of Negev, Beer-Sheva, Israel.
J Toxicol Clin Toxicol. 1992;30(2):245-58. doi: 10.3109/15563659209038636.
Scorpion envenomation is a common medical problem and life hazard in many countries of the world. Scientific investigations have addressed the interrelationship between the stimulatory effects of the venom on the autonomic nervous system and adrenals and the subsequent effects of released transmitters on the cardiovascular system. A number of clinical cardiovascular syndromes may dominate the initial clinical presentation after envenomation: the syndromes usually vary with the age of the victim, the size of the offender and the season. Central nervous system dysfunction is seen in children but rarely observed in adults; if accompanied by severe hypertension the clinical picture is consistent with acute hypertensive encephalopathy. Heart failure, pulmonary edema or a shock-like syndrome has been observed in 25% and hypertension in 30% to 77% of our patients. The electrocardiographic abnormalities recorded in the majority of the patients after envenomation include an "acute myocardial infarction-like pattern." Rhythm disturbances are frequent but conduction abnormalities are rare. Echocardiographic, radionuclide and experimental hemodynamic observations have provided evidence that heart failure and pulmonary edema after envenomation are multifactorial with diminished systolic performance following the initially increased left ventricular contractility and decreased ventricular diastolic compliance. Clinical laboratory data reporting increased catecholamine metabolite excretion and elevated plasma renin and aldosterone are consistent with the stimulatory effects of the venom on the autonomic nervous system. Treatment, including our experience with vasodilators and calcium channel blockers, is reviewed.
蝎子蜇伤在世界上许多国家都是常见的医学问题和生命威胁。科学研究已经探讨了毒液对自主神经系统和肾上腺的刺激作用之间的相互关系，以及释放的递质随后对心血管系统的影响。一些临床心血管综合征可能在蜇伤后的初始临床表现中占主导地位：这些综合征通常因受害者的年龄、蜇人蝎子的大小和季节而有所不同。中枢神经系统功能障碍在儿童中可见，但在成人中很少观察到；如果伴有严重高血压，临床表现与急性高血压脑病一致。在我们的患者中，25%观察到心力衰竭、肺水肿或类似休克的综合征，30%至77%观察到高血压。大多数患者蜇伤后记录的心电图异常包括“急性心肌梗死样模式”。心律失常很常见，但传导异常很少见。超声心动图、放射性核素和实验性血流动力学观察提供了证据，表明蜇伤后的心力衰竭和肺水肿是多因素的，最初左心室收缩力增加后收缩功能降低，心室舒张顺应性下降。临床实验室数据显示儿茶酚胺代谢产物排泄增加以及血浆肾素和醛固酮升高，这与毒液对自主神经系统的刺激作用一致。本文回顾了包括我们使用血管扩张剂和钙通道阻滞剂的经验在内的治疗方法。
