硫酸镁救治乌头碱中毒致顽固性室性心律失常

1例46岁男性患者误服生草乌、川乌粉约5 g后3 h出现意识障碍、全身抽搐；心电图检查示心室扑动，心率110次/min。立即电除颤，静脉推注胺碘酮，未复律。再次静脉推注胺碘酮，同时静脉推注利多卡因100 mg和15%硫酸镁8 ml（1 g），复律。心电监护示频发多源多形性室性期前收缩。继续持续静脉泵入胺碘酮和利多卡因。1 min后，再次出现多形性室性心动过速（室速），心率180~190次/min。静脉推注胺碘酮和利多卡因以及电复律均无效。再次静脉推注硫酸镁8 ml（1 g），室速仍存在但频率逐渐降至160~170次/min。遂第3次静脉推注硫酸镁8 ml（1 g），心率140~150次/min。10 min后，第4次静脉推注硫酸镁8 ml（1 g），心律转复。1 h后给予患者行血液灌流，最初1 h出现4次多形性室速，每次静脉推注硫酸镁（1~1 g）均有效。次日，患者恢复正常，心电图示窦性心律，心率75次/min。

Successful management of intractable ventricular arrhythmia due to aconitine poisoning with magnesium sulfate

A 46-year-old male patient mistook fresh radix aconite kusnezoffii and radix aconiti powder about 5 g and,after 3 hours,he developed consciousness disorder and generalized convulsion. The electrocardiogram showed ventricular flutter with a heart rate of 110 beats/min. Electric defibrillation and an IV push of amiodarone were given immediately. But his heart rhythm did not return to normal. An IV push of amiodarone was given again. Meanwhile an IV push of lidocaine 100 mg and 15% magnesium sulfate 8 ml （1 g）were administered. The heart rhythm normalized. The electrocardiogram revealed frequent multifocal polymorphic ventricular premature contractions. A continuous intravenous infusion of amiodarone and lidocaine via pump was continued. Two minutes later,polymorphic ventricular tachycardia recurred and the heart rate was 180-190 beats/min. None of IV push of amiodarone and lidocaine and electroversion was effective. After the second intravenous push of magnesium sulfate 8 ml（ 1 g ）,ventricular tachycardia remained however his heart rate decreased to 160-170 beats/min. So the patient received the third intravenous push of magnesium sulfate 8 ml（1 g）and his heart rate was 140-150 beats/min. Ten minutes later,the forth intravenous push of magnesium sulfate 8 ml （ 1 g ） was given and his heart rhythm normalized. Two hours later,the patient was treated with hemoperfusion. At the first one hour,he had polymorphic ventricular tachycardia four times and every intravenous push of magnesium sulfate 1-1 g was effective. Next day,the patient had no symptoms and the electrocardiogram showed sinus rhythm with a rate of 75 beats/min.