Amitai Y
Department of Pediatrics, Hadassah University Hospital, Mt. Scopus, Jerusalem, Israel.
Public Health Rev. 1998;26(3):257-63.
The most venomous scorpion species are Buthotus tamulus of India, the Leiurus quinquestriatus and Androctonus crassicauda of North Africa and the Middle East, the Tityus serrulatus of Brazil, and the Centruroides suffussus of Mexico. The severity of scorpion envenomation varies with the scorpion's species, age, and size, and is much greater in children. Systemic intoxication reflects the overstimulation of the CNS, the sympathetic and parasympathetic nervous system. Severity ranges from local pain and paresthesia to fatal cardiotoxicity and encephalopathy. Symptoms include: agitation, tachycardia, vomiting, abdominal pain, salivation, diaphoresis, dehydration, muscle rigidity and twitching, tremor, seizures, coma, pupillary changes, hyperthermia, tachyarrythmias and occasionally bradyarrhythmias, hypertension, and less often hypotension, cardiac failure, and priapism in males. Laboratory abnormalities include: hyperglycemia, leucocytosis, transient elevation of cardiac and pancreatic enzymes, ischemic changes in the ECG, and evidence of cardiac dysfunction on echocardiography. The principles of management are: observation, cardiac monitoring, supportive treatment with intravenous fluids and electrolytes, and a meticulous use of cardiovascular agents: vasodilators, adrenergic antagonists, or calcium channel blockers in the hypertensive phase; and inotropic agents in the event of hypotension. Antiarrhythmics such as lidocaine, may be required. There is increasing evidence for the efficacy of specific antivenom. The advance in supportive care and antivenom efficacy has markedly improved the outcome of patients with scorpion envenomation.
毒性最强的蝎子种类有印度的印度红蝎、北非和中东的以色列金蝎及肥尾蝎、巴西的巴西金幽灵蝎，以及墨西哥的墨西哥雕像木蝎。蝎子蜇伤的严重程度因蝎子的种类、年龄和大小而异，儿童受蜇伤后的反应更为严重。全身中毒反映出中枢神经系统、交感神经系统和副交感神经系统受到过度刺激。严重程度从局部疼痛和感觉异常到致命的心脏毒性和脑病不等。症状包括：烦躁不安、心动过速、呕吐、腹痛、流涎、出汗、脱水、肌肉僵硬和抽搐、震颤、癫痫发作、昏迷、瞳孔变化、体温过高、快速性心律失常，偶尔也会出现缓慢性心律失常、高血压，较少见的有低血压、心力衰竭以及男性阴茎异常勃起。实验室检查异常包括：高血糖、白细胞增多、心肌和胰腺酶短暂升高、心电图缺血性改变以及超声心动图显示的心脏功能障碍。治疗原则是：观察、心脏监测、静脉输液和电解质进行支持治疗，谨慎使用心血管药物：高血压阶段使用血管扩张剂、肾上腺素能拮抗剂或钙通道阻滞剂；低血压时使用强心剂。可能需要使用利多卡因等抗心律失常药物。越来越多的证据表明特异性抗蛇毒血清有效。支持治疗和抗蛇毒血清疗效的进步显著改善了蝎子蜇伤患者的预后。
