Intensive Care Unit, Habib Bourguiba University Hospital, Sfax, Tunisia.
Intensive Care Unit, Habib Bourguiba University Hospital, Sfax, Tunisia; Intensive Care Unit, Cayenne General Hospital, French Guiana.
Toxicon. 2020 Jul 30;182:54-58. doi: 10.1016/j.toxicon.2020.05.007. Epub 2020 May 16.
Scorpion envenoming is a frequent and deadly event in Tunisia. It is caused mainly by Androctonus australis and Buthus occitanus. Pulmonary edema and shock following scorpion envenoming are related to adrenergic cardiomyopathy, and are the main symptoms leading to death. Our aim was to search for the effect of dobutamine on "scorpion myocardiopathy" and to define the optimal dose of dobutamine to start with. This study was conducted in the medical surgical ICU of Habib Bourguiba University Hospital in Sfax - Tunisia. We included 21 patients with pulmonary edema or hemodynamic shock following scorpion envenoming. All patients were monitored using Swan-Ganz catheter. After a first check of the hemodynamic parameters (baseline), all patients received dobutamine infusion at 5, 10, and 15 μg/kg/min. The median age of patients was 19 years (IQR: 14-26) and 12 patients (57.1%) were males. On ICU admission, 11 patients (52.4%) had shock, all patients (100%) had pulmonary edema, 20 patients (95.2%) had neurologic manifestations, and 16 patients (76.2%) had gastro-intestinal manifestations. During ICU stay, 18 patients (85.7%) received mechanical ventilation (MV). The median duration of MV was 3 days (IQR: 2-4). The median duration of dobutamine administration was 4 days (IQR: 3-5). Cardiac index at baseline was 2.7 L/min/m2 (IQR: 2.3-3.2). Under dobutamine at 5, 10 and 15 μg/kg/min, it was 3.6 (IQR: 3.2-3.9), 4.0 (IQR: 2.9-4.8), and 4.1 (IQR: 3.6-4.9) respectively. Arterio-venous oxygen difference at baseline was 6.0 ml/dl (IQR: 5.0-7.0). Under dobutamine at 5, 10 and 15 μg/kg/min, it was 6.1 (IQR: 4.7-6.4), 3.9 (IQR: 3.4-4.3), and 3.9 (IQR: 3.1-4.7) respectively. The length of stay in ICU was 4 days (IQR: 4-5) and 2 patients died during ICU stay (9.5%). Our study confirms that cardiac dysfunction following scorpion envenomation in Tunisia improved well and safely under dobutamine infusion. The optimal dose of dobutamine to start with was between 5 and 10 μg/kg/min.
在突尼斯，蝎子蜇伤是一种常见且致命的事件。它主要由安德罗克妥司属和巴勒斯坦毒蛛属引起。蝎子蜇伤后发生肺水肿和休克与肾上腺素能性心肌病有关，是导致死亡的主要症状。我们的目的是寻找多巴酚丁胺对“蝎子心肌病变”的作用，并确定开始使用多巴酚丁胺的最佳剂量。这项研究在突尼斯斯法克斯的 Habib Bourguiba 大学医院的外科重症监护病房进行。我们纳入了 21 名因蝎子蜇伤而出现肺水肿或血流动力学休克的患者。所有患者均使用 Swan-Ganz 导管进行监测。在检查血流动力学参数（基线）后，所有患者均以 5、10 和 15μg/kg/min 的剂量输注多巴酚丁胺。患者的中位年龄为 19 岁（IQR：14-26），12 名患者（57.1%）为男性。入住 ICU 时，11 名患者（52.4%）发生休克，所有患者（100%）均有肺水肿，20 名患者（95.2%）有神经表现，16 名患者（76.2%）有胃肠道表现。在 ICU 期间，18 名患者（85.7%）接受机械通气（MV）。MV 的中位持续时间为 3 天（IQR：2-4）。多巴酚丁胺的中位给药时间为 4 天（IQR：3-5）。基线时的心指数为 2.7L/min/m2（IQR：2.3-3.2）。在多巴酚丁胺 5、10 和 15μg/kg/min 时，分别为 3.6（IQR：3.2-3.9）、4.0（IQR：2.9-4.8）和 4.1（IQR：3.6-4.9）。基线时的动静脉血氧差为 6.0ml/dl（IQR：5.0-7.0）。在多巴酚丁胺 5、10 和 15μg/kg/min 时，分别为 6.1（IQR：4.7-6.4）、3.9（IQR：3.4-4.3）和 3.9（IQR：3.1-4.7）。在 ICU 的住院时间为 4 天（IQR：4-5），有 2 名患者在 ICU 期间死亡（9.5%）。我们的研究证实，突尼斯蝎子蜇伤后心脏功能障碍在多巴酚丁胺输注下得到了很好且安全的改善。开始使用多巴酚丁胺的最佳剂量在 5 到 10μg/kg/min 之间。
