Ren Binbin, Wang Liming, Chen Kun, Chen Lin, Wang Huabin
Department of Infectious Disease, School of Medicine, Affiliated Jinhua Hospital, Zhejiang University, Jinhua, China.
Department of Intensive Care Unit, School of Medicine, Affiliated Jinhua Hospital, Zhejiang University, Jinhua, China.
Front Med (Lausanne). 2021 Nov 3;8:731163. doi: 10.3389/fmed.2021.731163. eCollection 2021.
Caowu, the main root of the plant, is widely used in China. Aconitine is the main toxic component of , which can cause a variety of malignant arrhythmias and lead to death. Four patients who developed malignant arrhythmia after drinking medicinal wine containing Caowu were reported in this study. Cardiac arrest occurred soon after symptom onset. All patients received venoarterial extracorporeal membrane oxygenation (VA-ECMO) support after conservative medical treatment had failed. Patients who were directly transferred to our hospital received VA-ECMO support earlier than patients who were first treated at a local hospital. One patient received hemoperfusion in the emergency room before VA-ECMO support; the other three patients began hemoperfusion after VA-ECMO treatment. Surviving patients who received VA-ECMO earlier after symptom onset showed no obvious neurological complications. The patient who received a longer cardiopulmonary resuscitation time but received hemoperfusion before VA-ECMO had mild neurological complications. The mortality rate was 25% (1 of 4 patients). Two patients had thrombotic complications in venous vessels. Cardiogenic shock due to refractory ventricular tachycardia caused by aconitine is lethal. Conservative supportive treatment did not provide a short-term antiarrhythmic effect and the cardiogenic shock was not well controlled. VA-ECMO treatment combined with hemoperfusion is promising temporary support to successfully treat aconitine-induced cardiogenic shock caused by refractory ventricular tachycardia.
草乌，即该植物的主根，在中国被广泛使用。乌头碱是草乌的主要毒性成分，可导致多种恶性心律失常并致人死亡。本研究报告了4例饮用含草乌药酒后患恶性心律失常的患者。症状发作后不久即发生心脏骤停。所有患者在保守药物治疗失败后均接受了静脉-动脉体外膜肺氧合（VA-ECMO）支持。直接转至我院的患者比先在当地医院治疗的患者更早接受VA-ECMO支持。1例患者在VA-ECMO支持前于急诊室接受了血液灌流；另外3例患者在VA-ECMO治疗后开始血液灌流。症状发作后更早接受VA-ECMO的存活患者未出现明显的神经并发症。心肺复苏时间较长但在VA-ECMO前接受血液灌流的患者有轻度神经并发症。死亡率为25%（4例患者中的1例）。2例患者出现静脉血管血栓并发症。乌头碱所致难治性室性心动过速引起的心源性休克是致命的。保守支持治疗未产生短期抗心律失常作用，心源性休克未得到有效控制。VA-ECMO治疗联合血液灌流有望作为一种临时支持手段成功治疗乌头碱所致难治性室性心动过速引起的心源性休克。
