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川乌(乌头的母根)和草乌(北乌头的块根)均含二萜类生物碱,主要为乌头碱。川乌或草乌使用不当可致中毒。人口服乌头碱3～5mg可致死。本文报告1例误服川乌草乌煎剂引致的心脏毒性。患者男,42岁,误服外用的由川乌30g和草乌30g制成的煎剂1000ml后1h出现四肢麻木、心慌、胸闷、头晕。1.5h后患者出现室性早搏,予以洗胃,静脉给予呋塞米和奥美拉唑。2h后患者出现浅昏迷,肌肉震颤,HR209次/min,BP67/25mmHg,心电图示室性心动过速和心室颤动。静脉给予胺碘酮、利多卡因及阿托品。3h后实验室检查示WBC12.4×109/L,Hb152g/L,AST812U/L,ALT205U/L。心电图示频发性室性早搏,阵发性室性心动过速。治疗包括给予地塞米松、多巴胺,利多卡因、生脉注射液、大黄煎剂及解毒汤(由黑豆,防风,蜂蜜,炙甘草制成)。6h后患者神志转清。3d后HR70次/min,R17次/min,SaO2100%,AST49U/L,ALT85U/L,心电图正常。5d后患者痊愈出院。
Chuanwu (Aconitum root) and Aconitum (Northern aconite root) contain diterpene alkaloids, mainly aconitine. Chuanwu or Aconitum can cause poisoning if used improperly. Aconitine oral administration of 3 ~ 5mg can be fatal. This article reports 1 case of accidental Chuan Wusao decoction-induced cardiotoxicity. Male, 42 years old, was taken by the Chuanwu 30g and Aconitum 30g 1000ml after 1h appeared numbness, palpitation, chest tightness, dizziness. 1.5h after patients with premature ventricular contractions, gastric lavage, intravenous furosemide and omeprazole. After 2 hours, the patient showed super coma, muscle tremors, HR209 beats / min, BP67 / 25mmHg, electrocardiogram ventricular tachycardia and ventricular fibrillation. Intravenous amiodarone, lidocaine and atropine. After 3h laboratory tests showed WBC12.4 × 109 / L, Hb152g / L, AST812U / L, ALT205U / L. ECG showed frequent premature ventricular contractions, paroxysmal ventricular tachycardia. Treatment included dexamethasone, dopamine, lidocaine, Shengmai injection, rhubarb decoction and detoxification soup (made from black beans, windproof, honey, Zhigancao). 6h after the patient consciousness clear. HR70 beats / min after 3 days, R17 beats / min, SaO2100%, AST49U / L, ALT85U / L, normal ECG. After 5d patients were discharged.