Bawaskar H S, Bawaskar P H
Bawaskar Hospital and Research Centre, Maharashtra, India.
Toxicon. 1994 Sep;32(9):1031-40. doi: 10.1016/0041-0101(94)90386-7.
Our aim was to assess clinically whether there was any benefit in adding a single dose of sublingual nifedipine (a slow calcium channel blocker) to prazosin in the management of the cardiovascular manifestations of envenoming by the Indian red scorpion (Mesobuthus tamulus). A total of 163 patients stung by this species was admitted to hospital at Mahad between January 1991 and October 1993. Cardiovascular abnormalities were hypertension (59), of whom 42 had bradycardia and 17 had tachycardia; pulmonary oedema (14), of whom eight had hypertension and six hypotension; supraventricular tachycardia (eight), of whom three had hypotension and one died. Of the remaining patients, 78 demonstrated severe excruciating local pain at the site of sting but had no systemic involvement. Nineteen patients with hypertension and tachycardia were given a single dose of sublingual nifedipine plus prazosin on admission, then prazosin alone repeated 6 hourly. Five patients with massive life-threatening pulmonary oedema recovered after being given intravenous sodium nitroprusside. Prazosin alone helped to alleviate cardiovascular manifestations in the remaining 52 victims. One patient was admitted in a deep coma, 12 hr after the sting, and died. Eight victims whose blood pressure had been controlled in hospital by nifedipine plus prazosin developed acute pulmonary oedema necessitating additional doses of prazosin for recovery. Fifty-two victims treated with prazosin alone did not develop pulmonary oedema and the drug appeared to hasten the recovery. In the presence of high blood pressure, tachycardia, a murmur and impending myocardial failure, nifedipine appeared to contribute to cardiopulmonary instability and to augment myocardial oxygen consumption. In this situation calcium channel blockers should probably be avoided.
我们的目的是从临床角度评估，在印度红蝎（印度杀人蝎）蜇伤所致中毒的心血管症状处理中，于哌唑嗪基础上加用单剂量舌下含服硝苯地平（一种慢钙通道阻滞剂）是否有益。1991年1月至1993年10月期间，共有163例被该种蝎子蜇伤的患者被收治于马哈德的医院。心血管异常情况包括高血压（59例），其中42例有心动过缓，17例有心动过速；肺水肿（14例），其中8例有高血压，6例有低血压；室上性心动过速（8例），其中3例有低血压，1例死亡。其余患者中，78例在蜇伤部位有严重剧痛，但无全身症状。19例有高血压和心动过速的患者入院时给予单剂量舌下含服硝苯地平加哌唑嗪，然后每6小时重复单独使用哌唑嗪。5例有严重危及生命的肺水肿患者在给予静脉注射硝普钠后康复。仅使用哌唑嗪有助于缓解其余52例受害者的心血管症状。1例患者在蜇伤12小时后入院时处于深度昏迷状态，最终死亡。8例在医院中血压通过硝苯地平加哌唑嗪得到控制的受害者发生了急性肺水肿，需要额外剂量的哌唑嗪才能康复。仅用哌唑嗪治疗的52例受害者未发生肺水肿，且该药似乎加速了康复。在存在高血压、心动过速、杂音和即将发生心肌衰竭的情况下，硝苯地平似乎会导致心肺不稳定并增加心肌耗氧量。在这种情况下，可能应避免使用钙通道阻滞剂。
