Original Articles Korean Circulation J 2000;30 7 : 급성 Aconitine 중독에의한심혈관계부작용에관한임상적관찰 김우식 임성식 강흥선 조정휘 김권삼 송정상 배종화 Cardiovascular Aspects of Acon

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1 Original Articles Korean Circulation J 2000;307: 급성 Aconitine 중독에의한심혈관계부작용에관한임상적관찰 김우식 임성식 강흥선 조정휘 김권삼 송정상 배종화 Cardiovascular Aspects of Aconitine Poisoning Woo Shik Kim, MD, Seong Shik Lim, MD, Heung Sun Kang, MD, Chung Whee Choue, MD, Kwon Sam Kim, MD, Jung Sang Song, MD and Jong Hoa Bae, MD Division of Cardiology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea ABSTRACT Background and ObjectivesThe Oriental herbal materials known as aconitine have long been used in oriental traditional medicine for their analgesic and antiinflammatory effects. Aconitine and its related alkaloids are known cardiotoxins with no therapeutic role in modern western medicine. We have studied the cardiovascular side effects of intoxication that took place in otherwise healthy individuals after ingestion of herbal decoctions containing aconite alkaloids. Materials and MethodDuring a six-year interval from 1990 to 1996, 9 cases of accidental herb-induced aconitine intoxication were managed in Kyung Hee university medical center. Hospital records were reviewed in detail. ResultsAll patients developed symptoms of aconitine toxicity within 4 hours of herb ingestion. The frequency of the order in cardinal symptoms of acute aconitine poisoning was nausea or vomiting, irritability, chest discomfort, dizziness, etc. Nine patients developed arrhythmias, including multifocal APC with aberrancy, multifocal VPC, ventricular tachycardia, etc. Administration of isotonic saline, dopamine, atropine and lidocaine with supportive cares brought clinical recovery and disappearance of arrhythmias in most cases within several hours. However, one case of acute aconitine poisoning had been dead of cardiac arrest due to ventricular fibrillation. ConclusionAconitine and its related alkaloids can cause toxic effects and even fatal poisoning. These cases point to the need for strict surveillance of herbal substances with low safety margins. Korean Circulation J 2000;307: KEY WORDSAconitine Arrhythmia. 서 론 855

2 Table 1. Clinical characteristics of the subjects Patient No. Sex M/F Age Ingestion of aconitine yrs Purpose Duration Symptom onset BP at presentation Treatment M 34 Arthralgia 1 day 4 h 80/50 G M 51 Neuralgia 1 day 3 h 90/60 G, D F 70 Arthralgia 34 month 2 h 120/70 G F 82 Suicide 7 day 3 h 80/50 G M 60 Neuralgia 1 day 1 h 80/40 G, A, L, D M 70 Neu ralgia 2 day 1 h 50/ L, D, DC, I F 58 Arthralgia 2 day 2 h 60/40 P F 61 Neur algia 1 day 1 h 80/60 G, L, DC M 13 Releaf of pain 1 day 1 h 70/40 CPR GGastric lavage DDopamine AAtrophine LLidocaine DCDC cardioversion IInderal P Temporary pacemakercprcardiopulmonary resurcitation 재료및방법 결과 856 Table 2. Electrocardiographic findings of the subjects Patient No. VPC ECG finding Complete AV block with junctional rhythm VPC bigeminy type Accelerated idioventricular rhythm VPC, Accelerated idioventricular rhythm Nonsustained monomorphic VT, Polymorphic VT, Polymorphic VT Korean Circulation J 2000;307:

림과 같다(Figs. 1 and 2). 내원시 다원성 심방조기박 회복되었으며, 이중 2명은 반복적인 DC cardioversion 동 및 빈번한 다원성 심실조기박동이 5명의 환자에서 을 시행하였다.

한 환자(VII)는 방실전도장애 소견을 보여 혈압유지를 위해 임시 심박조율기를 삽입하였고 한방에서 사용되는 약재는 7,000여 가지가 넘으며 약 20시간후 정상 심박동으로 회복되었다. 3명의 환자 그 중에서 약 150가지가 자주 사용된다고 한다.

1) Aconitum 속(屬) 식물은 전세계에 분포하고 있 는데 우리나라에서는 27종이 보고되어 있으며, 흔히 초오(草烏, Aconitum ciliare) 또는 부자(附子, Aconitum carmichaeli)의 뿌리를 가공하여 약재로 사용한 다.

3 림과 같다(Figs. 1 and 2). 내원시 다원성 심방조기박 회복되었으며, 이중 2명은 반복적인 DC cardioversion 동 및 빈번한 다원성 심실조기박동이 5명의 환자에서 을 시행하였다. 2명의 환자(VI, XI)에서 심정지가 생겨 나타났고, 이들중 3명(II, V, VI)은 치료중 각각 완전방 심폐소생술을 시행했으나 1명(XI)은 사망하였다. 실전도장애, 심실조기박동(bigeminy pattern), 가속성 심실고유율동 소견이 있었으며, 치료후 모두 정상 동조 고 찰 율로 돌아왔다. 한 환자(VII)는 방실전도장애 소견을 보여 혈압유지를 위해 임시 심박조율기를 삽입하였고 한방에서 사용되는 약재는 7,000여 가지가 넘으며 약 20시간후 정상 심박동으로 회복되었다. 3명의 환자 그 중에서 약 150가지가 자주 사용된다고 한다. 이 중 (V, VI, VIII)는 lidocaine을 투여하여 정상 심박동으로 에서 약 10가지 정도가 독성이 있는 것으로 알려져 있 다.1) Aconitum 속(屬) 식물은 전세계에 분포하고 있 는데 우리나라에서는 27종이 보고되어 있으며, 흔히 초오(草烏, Aconitum ciliare) 또는 부자(附子, Aconitum carmichaeli)의 뿌리를 가공하여 약재로 사용한 다. 한방에서는 이 약물들이 거풍제습(祛風除濕), 온경 지통(溫經止痛), 관절동통(關節疼痛) 등에 효과가 있는 중요한 한약재로 알려져 있다.2) 초오나 부자에는 C19 Fig. 1. The electrocardiography of case Ⅲ showing multifocal premature ventricular complexes and premature atrial complexs. diterpene계 알칼로이드가 함유되어 있으며 이들은 다 시 Aconitine계, Ignavine계 및 Atisine계로 나뉘는데 Fig. 2. The electrocardiogrphy of case Ⅷ showing polymorphic ventricular tachycardia. 857

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5 요약 연구목적 : 방법 : 결과 : 결론 : 중심단어 REFERENCES 1) Chan TYK, Chan JCN, Tomlinson B, Critchley JAJH. Chinese herbal medicines revisited: A Hong Kong perspective. Lancet 1993;342: ) Lee SI, Ahn DK, et al. Herbal medicine. ;1991. p.267-8, p ) Lee SW, Lee YJ, et al. Pharmacognosy. ;1975. p ) Yook CS, et al. Herbal medicine. The Korean pharmaceutical association;1994. p ) Kim SS, Oh SJ, Park HM. Bidirectional tachycardia. J Korean Med Assoc 1965;8: ) Chung HM, Lee HW, Park HM, Yoo UH, Oh SJ. Clinical observations of acute aconite poisoning with particular reference to arrhythmias. Korean J Intern Med 1969;12: ) Lee Y, Lee SY, Sun WJ, Jun KS, Paik HK, Kim KM. Clinical study on aconitine intoxication. Korean J Intern Med 1976;20: ) Wi SY, Yoo JJ, Moon MU, Hong KB, Choi KT, Ahn DS. Eleven cases of aconitine intoxication treated with atropine. Korean J Intern Med 1977;20: ) Park SB, Kim HK, Kang JS, Kim YK, Lee JS, Lee SD. A clinical study of aconite poisoning. Korean J Intern Med 1978;21: ) Hwangbo WH, Lee HS, Auh YS, Woo JY, Choi SC, Hub KD. Clinical study of acute aconite poisoning. Korean J Intern Med 1982;25: ) Jin YJ, Lee JH, Choi JH, Na BG, Nam GB, Kim DW, et al. A case of aconite intoxication and recurrent ventricular arrhythmia without apparent myocardial damage after 20,680 Joules DC shock. Korean Cire J 1997;27: ) Tai YT, But PPH, Young K, Lau CP. Cardiotoxicity after accidental herb-induced aconite poisoning. Lancet 1992; 340: ) Hong SA, Park CW, Kim MS, Shin SG, Yoon HI. Studies on the cardiotonic effect of aconiti tuber. Seoul J Med 1980; 21: ) Tanz RD. Pharmacology of aconitine-induced automaticity on in vitro cat myocardial preparations.. Effects of refractory period prolongation, reduced sodium and tetrodotoxin. J Pharmacol Exp Ther 1974;191: ) Yamada Y, Shoyama Y, Nishioka I. Characteristics of clonally propagated Aconitum charmichaeli Debx. by tissue culture. Japan J Pharmacog 1991;45:

6 16) Catterall WA. Neurotoxins that act on voltage-sensitive sodium channels in excitable membranes. Annu Rev Pharmacol Toxicol 1980;2: ) Pepper K, Trautwein W. The effect of aconitine on the membrane current in cardiac muscle. Pfluggers Archiv 1967;296: ) Manig JP, Herman EH. Toxic response of the heart and vascular systems. In: Amdur MO, Dovil J, Klaassen CD. Casarett and Doull s toxicology. The Basic Sciences of Poisons. Pergamon Press, New York;1991. p ) Honerjager P, Meissner A. The positive inotropic effect of aconitine. Naunyn-Schmiedebergs Arch Pharmacol 1983; 322: ) Lee JH, Kim KR. A clinical study of aconitine poisoning. J Korean Soc Emerg Med 1995;6: Korean Circulation J 2000;307:

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386-390.hwp 386 HANYANG MEDICAL REVIEWS Vol. 29 No. 4, 2009 우리나라 미숙아의 통계와 의료비용 Statistics and Medical Cost of Preterm in Korea 윤혜선 을지대학교 노원을지병원 소아청소년과학교실 Hye Sun Yoon, M.D., Ph.D., Department of Pediatrics, Nowon