Original Articles Korean Circulation J 2000;307:855-860 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;307:855-860 KEY WORDSAconitine Arrhythmia. 서 론 855
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;307:855-860
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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