부산대학교 도서관

OBJECTIVE: Evaluation of right ventricular (RV) performance in patients presenting with pulmonary edema following scorpion envenomation. DESIGN: Cohort study. SETTING: Medical intensive care unit of a teaching hospital. PATIENTS: Eight consecutive adult patients stung by yellow scorpion Androctonus australis and presenting with pulmonary edema at hospital admission. INTERVENTIONS: In all patients, standard hemodynamic parameters and RV volumes were measured using a pulmonary artery catheter equipped with a rapid responding thermistor enabling measurement of RV ejection fraction (RVEF). MEASUREMENTS: Hemodynamic evaluation was performed at the time of hospital admission prior to any therapeutic intervention and just before the removal of the pulmonary catheter (2.3 plus minus 0.5 days after admission) in the surviving patients (n equals 7). RESULTS: All patients had a decreased RVEF (24 plus minus 7%) and cardiac index (2.44 plus minus 0.5 L/min/m) and increased pulmonary artery occlusion pressure (23 plus minus 6 mm Hg). Right ventricular end-systolic pressure/volume ratio was decreased (.56 plus minus .19 mm Hg/mL/m), suggesting an altered RV contractility. Follow-up evaluation performed in survivors, without any inotropic support, showed hemodynamic changes reflecting a trend toward full recovery. Right ventricular ejection fraction and cardiac index improved markedly (from 24 plus minus 7% to 39 plus minus 10% and from 2.44 plus minus 0.5 to 4 plus minus .3 L/min/m, respectively). Pulmonary artery occlusion pressure, peak systolic pulmonary artery pressure, and mean pulmonary artery pressure decreased significantly from baseline values (12 plus minus 3 mm Hg, 29 plus minus 5 mm Hg, and 20 plus minus 4 mm Hg, respectively). Right ventricular end systolic pressure/volume ratio remained almost constant, suggesting that afterload enhancement accounted predominantly for RVEF improvement. CONCLUSION: These data show that RV function impairment is associated with left ventricular dysfunction, suggesting similarities between left ventricular and RV alterations following severe scorpion envenomation providing further arguments to the hypothesis of scorpionic myocarditis.(CHEST 1995; 108:682-87)