急性乌头碱中毒伴室性心律失常并发消化道出血救治成功一例

A Successfully Treated Case of Acute Aconitine Poisoning Complicated by Ventricular Arrhythmia and Gastrointestinal Hemorrhage

摘要: 目的：探讨急性乌头碱中毒合并室性心律失常及消化道出血的临床特征与救治策略。方法：报道1例误服“羊角七”致急性乌头碱中毒患者的诊疗经过。患者表现为多形性室速、室颤及休克，伴进行性血红蛋白及血小板下降，最终并发消化道出血。治疗包括气管插管机械通气、洗胃、活性炭吸附、抗心律失常(利多卡因/胺碘酮)、血管活性药物、血液净化(CVVH联合血液灌流)及输血支持等综合措施。结果：经早期血液净化清除毒素、纠正心律失常及休克后，患者室性心律失常终止，血流动力学稳定，但治疗期间出现血红蛋白进行性下降(102→72 g/L)，结合影像学及粪便隐血阳性，诊断为消化道出血。经抑酸护胃、输血等对症处理后出血控制，最终康复出院。结论：乌头碱中毒需早期血液净化联合抗心律失常治疗，消化道出血可能为血液净化并发症或毒素介导的肠道损伤。动态监测凝血功能及血红蛋白变化，及时干预是救治成功的关键。

Abstract: Objective: To summarize the clinical characteristics and management of acute aconitine poisoning with ventricular arrhythmias and gastrointestinal bleeding. Methods: A case of acute poisoning caused by accidental ingestion of “Yangjiaoqi” (Aconitum plant) was reported. The patient presented with polymorphic ventricular tachycardia, ventricular fibrillation, and shock, accompanied by progressive hemoglobin decline and thrombocytopenia, ultimately complicated by gastrointestinal bleeding. Interventions included endotracheal intubation, gastric lavage, activated charcoal adsorption, antiarrhythmic therapy (lidocaine/amiodarone), vasopressors, blood purification (CVVH combined with hemoperfusion), and blood transfusion. Results: Early blood purification effectively cleared toxins and stabilized hemodynamics, terminating ventricular arrhythmias. However, hemoglobin dropped from 102 to 72 g/L during treatment, with positive fecal occult blood suggesting gastrointestinal bleeding. Bleeding was controlled after acid suppression and transfusion. The patient recovered fully and was discharged. Conclusion: Combined blood purification and antiarrhythmic therapy are critical in aconitine poisoning. Gastrointestinal bleeding may result from blood purification complications or toxin-induced mucosal injury. Close monitoring of coagulation and hemoglobin, along with timely intervention, is essential for successful outcomes.