Bush Sean P, Green Steven M, Moynihan James A, Hayes William K, Cardwell Michael D
Department of Emergency Medicine, Loma Linda University School of Medicine, Medical Center and Children's Hospital, Loma Linda, CA, USA.
Ann Emerg Med. 2002 Dec;40(6):619-24. doi: 10.1067/mem.2002.129939.
Southern Pacific rattlesnake (Crotalus helleri ) venom is not 1 of the 4 venoms used to produce Crotalidae polyvalent immune Fab (ovine) (CroFab; FabAV). There is currently no published clinical experience regarding the efficacy of this new antivenom for confirmed C helleri envenomation, and animal data suggest greatly diminished efficacy. We assessed the efficacy of FabAV for patients with confirmed C helleri envenomation.
We conducted a prospective observational study of 23 consecutive rattlesnake envenomations that were treated with FabAV at our center. Patients were excluded if the species of snake could not be confirmed, if FabAV antivenom was not given, or if Antivenin (Crotalidae) polyvalent (equine) was given. We collected serial physical examination and laboratory data over a 24-hour period to serially evaluate the severity score and performed follow-up to evaluate delayed reactions.
There were 15 patients who received FabAV and had the species of rattlesnake confirmed (9 C helleri, 4 C scutulatus scutulatus, 1 C mitchellii pyrrhus, 1 C ruber ruber ). C helleri envenomations demonstrated similar improvement in serial snakebite severity scores to those of other species. Three patients treated with scheduled dosing had recurrence of progressive swelling (2 C helleri and 1 C mitchellii pyrrhus ) during the 24-hour study period.
We observed similar improvement in FabAV-treated patients with C helleri envenomation compared with those of other species and conclude that this treatment in standard doses appears efficacious for bites by this species. Progressive swelling may recur despite scheduled dosing.
南太平洋响尾蛇（Crotalus helleri）毒液并非用于生产响尾蛇科多价免疫Fab（羊）（CroFab；FabAV）的4种毒液之一。目前尚无关于这种新型抗蛇毒血清对确诊的C helleri蛇咬伤疗效的临床经验报道，动物实验数据显示其疗效大幅降低。我们评估了FabAV对确诊为C helleri蛇咬伤患者的疗效。
我们对在本中心接受FabAV治疗的23例连续响尾蛇咬伤患者进行了一项前瞻性观察研究。如果无法确认蛇的种类、未给予FabAV抗蛇毒血清或给予了抗蛇毒血清（响尾蛇科）多价（马），则将患者排除。我们在24小时内收集了系列体格检查和实验室数据，以连续评估严重程度评分，并进行随访以评估迟发反应。
有15例患者接受了FabAV治疗且响尾蛇种类得到确认（9例C helleri，4例C scutulatus scutulatus，1例C mitchellii pyrrhus，1例C ruber ruber）。C helleri蛇咬伤患者的系列蛇咬伤严重程度评分改善情况与其他种类相似。3例按计划给药治疗的患者在24小时研究期间出现了渐进性肿胀复发（2例C helleri和1例C mitchellii pyrrhus）。
我们观察到，与其他种类的蛇咬伤患者相比，接受FabAV治疗的C helleri蛇咬伤患者有类似的改善情况，并得出结论，标准剂量的这种治疗方法对该种类的咬伤似乎有效。尽管按计划给药，渐进性肿胀仍可能复发。
