乌头类生物碱中毒临床特征及预后危险因素分析

Clinical features and prognostic risk factors analysis of aconite alkaloid poisoning

关键词: 乌头类生物碱  中毒  临床特征  预后

Keywords: aconite alkaloids  poisoning  clinical features  prognosis

摘 要: 目的 分析乌头类生物碱中毒患者的临床特征以及影响中毒严重程度的危险因素,为乌头类生物碱中毒的防治提供参考。方法 收集 2014 年 1 月至 2023 年 12 月楚雄州人民医院急诊科收治的 94 例乌头属植物中毒患者的一般资料、中毒严重程度评分(PSS)、毒物来源、中毒原因、时间、临床症状、实验室检查结果、救治过程等资料;依据有无休克及 PSS 评分评估预后。结果 94 例患者平均年龄(60.04±11.58)岁,男女比例 2.9︰1,中毒时间呈明显的季节性特征, 以秋冬季节多发。中毒表现为口周及面部感觉异常和麻木、心律失常、休克、呼吸衰竭等。给予血液灌流 21 例(22.3%)、抗心律失常 86 例(91.5%)、气管插管 12 例(12.8%)、心脏起搏器植入 4 例(4.3%)。90 例(95.7%)患者治愈出院、4 例(4.3%)死亡。统计分析显示室速、室颤是乌头碱中毒患者发生休克及 PSS 评分增加的独立危险因素。结论 乌头属植物中毒以中老年男性为主;中毒后出现难以控制的室颤是主要死亡原因, 尤以外用药酒内服中毒死亡率较高。

Abstract: Objective To analyze the clinical characteristics of patients with aconite alkaloid poisoning and the risk factors affected the severity of poisoning,thereby provide a reference for the prevention and treatment for aconite alkaloid poisoning.Methods Data from 94 patients with aconite poisoning admitted to the emergency department of Chuxiong Prefecture People􀆳s Hospital from January 2014 to December 2023 were collected,including general information, poisoning severity score (PSS),source of poison, cause of poisoning, time,clinical symptoms, laboratory examination results,and treatment process,etc.; prognosis was assessed based on the presence or absence of shock and PSS score. Results The results showed that the average age of the 94 patients was 60.04±11.58 years with a male-to-female ratio of 2. 9︰1,the poisoning showed significant seasonal characteristic, occurred more frequently in autumn and winter, the symptoms of poisoning included perioral and facial abnormal sensations and numbness,arrhythmias,shock, and respiratory failure, etc.;21 cases (22.3%) received blood perfusion,86 cases (91.5%) received antiarrhythmic treatment,12 cases (12.8%) received endotracheal intubation,4 cases (4.3%) received pacemaker implantation; 90 patients (95.7%) were cured and discharged, while 4 patients (4.3%) died. Statistical analysis indicated that ventricular tachycardia and ventricular fibrillation were the independent risk factors for shock and increase of PSS score in patients with aconite alkaloid poisoning. Conclusion The results suggested that the aconitum plants poisoning most commonly occurs in middle-aged and elderly men,uncontrollable ventricular fibrillation after poisoning is the main cause of death,and the mortality rate is higher for poisoning after ingestion of external medicinal wines.