[논문]유기인계 중독에 의한 심근손상 환자에서의 경흉부 심장 초음파검사를 사용한 심장기능평가

이윤석; 김오현; 김형일; 차경철; 김현; 이강현; 황성오; 차용성

유기인계 중독에 의한 심근손상 환자에서의 경흉부 심장 초음파검사를 사용한 심장기능평가
Evaluation of Cardiac Function by Transthoracic Echocardiography in Patients with Myocardial Injury Secondary to Organophosphate Poisoning 원문보기

대한임상독성학회지 = Journal of the Korean society of clinical toxicology, v.13 no.2, 2015년, pp.62 - 70

이윤석 (연세대학교 원주의과대학 응급의학과) , 김오현 (연세대학교 원주의과대학 응급의학과) , 김형일 (연세대학교 원주의과대학 응급의학과) , 차경철 (연세대학교 원주의과대학 응급의학과) , 김현 (연세대학교 원주의과대학 응급의학과) , 이강현 (연세대학교 원주의과대학 응급의학과) , 황성오 (연세대학교 원주의과대학 응급의학과) , 차용성 (연세대학교 원주의과대학 응급의학과)

Abstract ▼ AI-Helper

Purpose: Cardiac complications may occur in cases of organophosphate (OP) poisoning. However, a few studies regarding patterns of cardiac toxicity as determined by transthoracic echocardiography (TTE) after exposure to OP have been reported. In the current study, the authors examined cardiac functions using TTE in patients with myocardial injury caused by exposure to OP. Methods: A retrospective review was conducted on 16 consecutive cases of OP poisoning with myocardial injury (defined as elevated troponin I within 48 hours of arrival at the regional emergency center in South Korea and diagnosed and treated at the center from January 2012 to November 2014. Results: TTE was performed in 11 (69%) of the 16 patients with an elevated troponin I (TnI) level within 48 hours. Of these 11 patients, 5 patients (45.5%) exhibited reduced ejection fraction (EF), and 3 exhibited regional wall motion abnormality (RWMA). Two patients (18.2%) had both reduced systolic function and RWMA. Two of the 5 patients with reduced EF returned to normal systolic function, however two patients did not regain normal systolic function after admission. One patient expired due to multiple organ failure, and 4 patients were transferred with a moribund status. Twelve of 15 patients who survived to discharge (at 4 to 35 months) were followed. Five of these patients died during follow-up and 7 survived without further complications. Conclusion: OP can cause reversible cardiac dysfunction including reduced systolic function and RWMA. Serum TnI may be useful for initial assessment of cardiac function during the workup of patients suffering from OP poisoning. After the initial assessment of cardiac enzyme, further evaluation with TTE in patients with abnormal cardiac enzyme will be necessary to understand the cardiac toxicity.

주제어

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제안 방법

We assessed atropine dosage for 48 hours as this drug may affect the heart due to atropine induced tachycardia. Arterial blood gas testing was performed and serum lactate levels were measured. Cardiac biochemical markers including creatine kinase MB (CK-MB), TnI (Siemens Healthcare Diagnostics Inc.
Five patients (patients 5, 7, 9, 11, and 13) showed decreased ejection fraction on TTE, and 2 of these (patients 7 and 9) also showed RWMA. Follow-up TTE was performed in 4 patients (patients 5, 7, 9, and 11) to determine whether ejection fraction had recovered, and this was found to be so in patients 5 and 11 but not in patients 7 and 9, which both maintained a reduced ejection fraction and RWMA (Table 6). However, patient 7 survived for 24 months without any signs or symptoms of heart failure.

대상 데이터

Ten of the 16 patients were men (62.5%), and the ages of patients ranged from 29 to 91 years with a mean of 61±17 years.
This retrospective observational study was conducted on 16 consecutive patients with acute OP poisoning that presented with myocardial injury, defined as an elevated troponin I (TnI) level, within 48 hours of arrival at the regional emergency department (ED) in South Korea, between January 2012 and November 2014. The exclusion criteria applied were; age <18 years, poisoning by any additional agent (with the exception of alcohol), acute coronary syndrome, end stage renal disease, no elevation of TnI within 48 hours, and cardiac arrest at ED arrival.

성능/효과

The exclusion criteria applied were; age <18 years, poisoning by any additional agent (with the exception of alcohol), acute coronary syndrome, end stage renal disease, no elevation of TnI within 48 hours, and cardiac arrest at ED arrival.
In particular, volumes of OPs ingested and times elapsed between ingestion and ED arrival may have been over or underestimated. Third, since the percentages of OP, solvent, and surfactant in the various OP formulations were unknown, their clinical influences could not be determined.Forth, evaluation of status of alcohol usage will be necessary.

후속연구

This study has several limitations. First, due to the small number of patients studied, strong conclusions cannot be drawn from our data; therefore, a larger scale prospective study is necessary. Second, it is limited by its retrospective and observational design, and as a result, not all relevant assessment parameters could be included.

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