Nouira S, Abroug F, Haguiga H, Jaafoura M, Boujdaria R, Bouchoucha S
Service de Réanimation Polyvalente, Hopital Universitaire de Monastir, Tunisia.
Chest. 1995 Sep;108(3):682-7. doi: 10.1378/chest.108.3.682.
Evaluation of right ventricular (RV) performance in patients presenting with pulmonary edema following scorpion envenomation.
Cohort study.
Medical intensive care unit of a teaching hospital.
Eight consecutive adult patients stung by yellow scorpion Androctonus australis and presenting with pulmonary edema at hospital admission.
In all patients, standard hemodynamic parameters and RV volumes were measured using a pulmonary artery catheter equipped with a rapid responding thermistor enabling measurement of RV ejection fraction (RVEF).
Hemodynamic evaluation was performed at the time of hospital admission prior to any therapeutic intervention and just before the removal of the pulmonary catheter (2.3 +/- 0.5 days after admission) in the surviving patients (n = 7).
All patients had a decreased RVEF (24 +/- 7%) and cardiac index (2.44 +/- 0.5 L/min/m2) and increased pulmonary artery occlusion pressure (23 +/- 6 mm Hg). Right ventricular end-systolic pressure/volume ratio was decreased (.56 +/- .19 mm Hg/mL/m2), suggesting an altered RV contractility. Follow-up evaluation performed in survivors, without any inotropic support, showed hemodynamic changes reflecting a trend toward full recovery. Right ventricular ejection fraction and cardiac index improved markedly (from 24 +/- 7% to 39 +/- 10% and from 2.44 +/- 0.5 to 4 +/- .3 L/min/m2, respectively). Pulmonary artery occlusion pressure, peak systolic pulmonary artery pressure, and mean pulmonary artery pressure decreased significantly from baseline values (12 +/- 3 mm Hg, 29 +/- 5 mm Hg, and 20 +/- 4 mm Hg, respectively). Right ventricular end systolic pressure/volume ratio remained almost constant, suggesting that afterload enhancement accounted predominantly for RVEF improvement.
These data show that RV function impairment is associated with left ventricular dysfunction, suggesting similarities between left ventricular and RV alterations following severe scorpion envenomation providing further arguments to the hypothesis of scorpionic myocarditis.
评估蝎子蜇伤后出现肺水肿患者的右心室（RV）功能。
队列研究。
一家教学医院的医学重症监护病房。
连续8例被黄肥尾蝎蜇伤且入院时出现肺水肿的成年患者。
所有患者均使用配备快速响应热敏电阻的肺动脉导管测量标准血流动力学参数和右心室容积，以测定右心室射血分数（RVEF）。
在所有存活患者（n = 7）中，于入院时在任何治疗干预前以及拔除肺动脉导管前（入院后2.3±0.5天）进行血流动力学评估。
所有患者的右心室射血分数（24±7%）和心脏指数（2.44±0.5 L/min/m²）均降低，肺动脉闭塞压升高（23±6 mmHg）。右心室收缩末期压力/容积比降低（0.56±0.19 mmHg/mL/m²），提示右心室收缩性改变。在未使用任何正性肌力药物支持的情况下，对存活患者进行的随访评估显示血流动力学变化反映出完全恢复的趋势。右心室射血分数和心脏指数显著改善（分别从24±7%提高到39±10%以及从2.44±0.5提高到4±0.3 L/min/m²）。肺动脉闭塞压、肺动脉收缩压峰值和平均肺动脉压较基线值显著降低（分别为12±3 mmHg、29±5 mmHg和20±4 mmHg）。右心室收缩末期压力/容积比几乎保持不变，表明后负荷增加主要是右心室射血分数改善的原因。
这些数据表明右心室功能损害与左心室功能障碍相关，提示严重蝎子蜇伤后左心室和右心室改变具有相似性，为蝎毒性心肌炎假说提供了进一步依据。
