中藥草烏引起心室頻脈及Torsades de Pointes 病例報告
摘要
Aconitum carmichaelii has long served together with aconitum kusnezoffii, as the main source of the Chinese medicinal aconite drugs: Chuanwu (wu t'ou) and Caowu. All aconitine alkaloids exhibit significant analgesic, antiinflammatory and cardiotonic effects and have been used mainly for the treatment of musculoskeletal disorders. They contain the highly toxic C19 diterpenoid alkaloids of aconitine, mesoaconitine and hypoaconitine. A 56 year old man became unwell about 20 minutes after ingesting these herbs and his symptoms lasted for about 4 days. In addition to the typical gastrointestinal (nausea, vomiting, diarrhea and abdominal pain) and neurological (generalized weakness, numbness and paraesthesis, esp. peripheral toe and finger tips) features of aconitine poisoning, there was evidence of cardiotoxicity (hypotension and ventricular ectopics, Torsades de pointes). Management of such patients should include measures to enhance elimination and close monitoring for cardiotoxicity. Legislation controlling the use of such herbs should be considered and the need for surveillance of herbal substances with low margins of safety is highlighted. All clinicians should be alerted to the potential toxicity of ”Chuanwu” and ”Caowu”.