Smalligan Roger, Cole Judy, Brito Narcissa, Laing Gavin D, Mertz Bruce L, Manock Steven, Maudlin Jeffrey, Quist Brad, Holland Gary, Nelson Stephen, Lalloo David G, Rivadeneira Gonzalo, Barragan Maria Elena, Dolley Daniel, Eddleston Michael, Warrell David A, Theakston R David G
Hospital Vozandes del Oriente, Shell, Pastaza, Ecuador.
BMJ. 2004 Nov 13;329(7475):1129. doi: 10.1136/bmj.329.7475.1129.
To compare the efficacy and safety of three polyspecific antivenoms for bites by pit vipers.
Randomised double blind comparative trial of three antivenoms.
Shell, Pastaza, southeastern Ecuador.
210 patients with incoagulable blood were recruited from 221 consecutive patients admitted with snake bite between January 1997 and December 2001.
One of three antivenoms manufactured in Brazil, Colombia, and Ecuador, chosen for their preclinical potency against Ecuadorian venoms.
Permanent restoration of blood coagulability after 6 and 24 hours.
The snakes responsible for the bites were identified in 187 cases: 109 patients (58%) were bitten by Bothrops atrox, 68 (36%) by B bilineatus, and 10 (5%) by B taeniatus, B brazili, or Lachesis muta. Eighty seven patients (41%) received Colombian antivenom, 82 (39%) received Brazilian antivenom, but only 41 (20%) received Ecuadorian antivenom because the supply was exhausted. Two patients died, and 10 developed local necrosis. All antivenoms achieved the primary end point of permanently restoring blood coagulability by 6 or 24 hours after the start of treatment in > 40% of patients. Colombian antivenom, however, was the most effective after initial doses of 20 ml (two vials), < 70 ml, and any initial dose at both 6 and 24 hours. An initial dose of 20 ml of Colombian antivenom permanently restored blood coagulability in 64% (46/72) of patients after 6 hours (P = 0.054 compared with the other two antivenoms) and an initial dose of < 70 ml was effective at 6 hours (65%, P = 0.045) and 24 hours (99%, P = 0.06). Early anaphylactoid reactions were common (53%, 73%, and 19%, respectively, for Brazilian, Colombian, and Ecuadorian antivenoms, P < 0.0001) but only three reactions were severe and none was fatal.
All three antivenoms can be recommended for the treatment of snakebites in this region, though the reactogenicity of Brazilian and Colombian antivenoms is a cause for concern.
比较三种多价抗蛇毒血清治疗蝰蛇咬伤的疗效和安全性。
三种抗蛇毒血清的随机双盲对照试验。
厄瓜多尔东南部帕斯塔萨省谢尔。
从1997年1月至2001年12月连续收治的221例蛇咬伤患者中招募了210例血液无法凝固的患者。
选用巴西、哥伦比亚和厄瓜多尔生产的三种抗蛇毒血清之一，这些抗蛇毒血清对厄瓜多尔蛇毒具有临床前效力。
6小时和24小时后血液凝固性的永久恢复情况。
在187例病例中确定了致伤蛇种：109例患者（58%）被矛头蝮咬伤，68例（36%）被双色矛头蝮咬伤，10例（5%）被饰纹矛头蝮、巴西矛头蝮或巨蝮咬伤。87例患者（41%）接受了哥伦比亚抗蛇毒血清，82例（39%）接受了巴西抗蛇毒血清，但只有41例（20%）接受了厄瓜多尔抗蛇毒血清，因为其供应已耗尽。2例患者死亡，10例出现局部坏死。所有抗蛇毒血清在治疗开始后6小时或24小时使超过40%的患者血液凝固性永久恢复，达到了主要终点。然而，哥伦比亚抗蛇毒血清在初始剂量为20毫升（两小瓶）、小于70毫升以及6小时和24小时的任何初始剂量时最为有效。初始剂量为20毫升的哥伦比亚抗蛇毒血清在6小时后使64%（46/72）的患者血液凝固性永久恢复（与其他两种抗蛇毒血清相比，P = 0.054），初始剂量小于70毫升在6小时（65%，P = 0.045）和24小时（99%，P = 0.06）时有效。早期类过敏反应很常见（巴西、哥伦比亚和厄瓜多尔抗蛇毒血清分别为53%、73%和19%，P < 0.0001），但只有3例反应严重，无一例致命。
所有三种抗蛇毒血清均可推荐用于该地区蛇咬伤的治疗，不过巴西和哥伦比亚抗蛇毒血清的反应原性令人担忧。
