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大量洋地黄中毒继发消化道出血性坏死(作者译)

[Haemorrhagic necrosis of the digestive tract consecutive to massive digitalis intoxication (author's transl)].

作者信息

Patart O, Desnos M, Leroy G, Lauru Y, Mogenet M, Garbay M, Barrillon A, Gerbaux A

出版信息

Nouv Presse Med. 1981 Apr 25;10(18):1489-91.

PMID:6973139
Abstract

A 60-year-old man under digitalis treatment for hypertensive heart tried to commit suicide by absorbing a 15 mg dose of digitoxin. Severe intestinal bleeding occurred 12 hours later, followed by pseudo-occlusive syndrome and ischaemia of the distal lower limbs. On abdominal incision the whole gut was found to be invaded by haemorrhagic necrosis and perforated on three points. The patients subsequently died of peritonitis. The responsibility of digitoxin in these events was demonstrated by the absence of any other cause of ischaemia, such as heart failure, shock, arrhythmia, consumption coagulopathy or use of sympathomimetic drugs. This case shows that the vasoconstrictor effect of digitalis, experimentally demonstrated but clinically controversial, is a reality, and that digitalis compounds are contra-indicated in patients with haemorrhagic necrosis of the digestive tract.

摘要

一名60岁男性因高血压性心脏病接受洋地黄治疗,他服用了15毫克洋地黄毒苷企图自杀。12小时后出现严重肠道出血,随后发生假性梗阻综合征和下肢远端缺血。剖腹探查发现整个肠道均被出血性坏死侵犯,并在三个部位穿孔。患者随后死于腹膜炎。由于不存在其他缺血原因,如心力衰竭、休克、心律失常、消耗性凝血病或使用拟交感神经药物,因此证实了洋地黄毒苷与这些事件有关。该病例表明,洋地黄的血管收缩作用虽在实验中得到证实,但在临床上存在争议,它确实存在,并且洋地黄类化合物在患有消化道出血性坏死的患者中是禁忌的。

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