抗蛇毒血清（ASV）的合理使用：血液毒性蛇咬伤不同治疗方案的试验

Rational use of anti-snake venom (ASV): trial of various regimens in hemotoxic snake envenomation.

作者信息

Srimannarayana J, Dutta T K, Sahai A, Badrinath S

机构信息

Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry.

出版信息

J Assoc Physicians India. 2004 Oct;52:788-93.

PMID:15909856

Abstract

BACKGROUND

Viperine snake bites cause hemotoxicity in the form of coagulation dysfunction. Optimal dose requirement of anti-snake venom (ASV) and duration of therapy in such situation have not yet been fully explored. Our aim in this study was to compare two low-dose continuous infusion regimes with the standard high dose intermittent bolus regime in treating systemic envenomation and preventing its recurrence.

METHODS

A prospective interventional study was conducted on 90 adult patients with snake bite with hemotoxicity. Patents were allocated into three treatment regimes, each regime being tried on 30 patients. Regimen I (standard high dose regimen) consisted of conventional, intermittent bolus dosage of 100 ml of ASV as a loading dose followed by 50 ml every six hours till whole blood coagulation time (CT) became normal. Regimen II consisted of 30 ml of ASV as a loading dose followed by 30 ml continuous infusion every six hours till two CTs at an interval of six hours were normal and a further dose of 30ml over 24 hours. Regimen III was similar to Regimen II in all aspects except that loading dose was 70 ml (instead of 30 ml).

RESULTS

In patients with mild envenomation, even though the average requirement of ASV was only marginally lower in Regimen II (128.6 ml) as compared to in Regimen I (137.5 ml), one patient on Regimen I had relapse of coagulation dysfunction. In patients with moderate envenomation, average requirement of ASV was 221.3 ml and 179 ml in Regimens II and III respectively, which was much less than in Regimen I (343.8 ml) (p values 0.05 and 0.01 respectively). Further, no patient receiving Regimen III had relapse of coagulation dysfunction. In severe envenomation, average dose of ASV required was almost similar in Regimens II and III, i.e., 213.7 ml and 233.7 ml respectively, as compared to 433.3 ml required in Regimen I (p values 0.02 and 0.001 respectively). However, time lapse for CT normalization was only 18 hours in Regimen III as compared to 23.6 hours and 24 hours in Regimens I and II respectively.

CONCLUSION

Regimens consisting of continuous intravenous infusion of ASV i.e., Regimen II in mild envenomation and Regimen III in moderate and severe envenomation are likely to make significant saving of ASV and reduction of recurrence of coagulation dysfunction.

摘要

背景

蝰蛇咬伤会导致以凝血功能障碍为形式的血液毒性。在这种情况下，抗蛇毒血清（ASV）的最佳剂量需求和治疗持续时间尚未得到充分研究。我们这项研究的目的是比较两种低剂量持续输注方案与标准高剂量间歇推注方案在治疗全身中毒及预防其复发方面的效果。

方法

对90例有血液毒性的成年蛇咬伤患者进行了一项前瞻性干预研究。将患者分为三种治疗方案，每种方案在30例患者身上进行试验。方案I（标准高剂量方案）包括常规的100 ml ASV间歇推注作为负荷剂量，随后每6小时50 ml，直至全血凝固时间（CT）恢复正常。方案II包括30 ml ASV作为负荷剂量，随后每6小时持续输注30 ml，直至间隔6小时的两次CT正常，然后在24小时内再给予30 ml剂量。方案III在各方面与方案II相似，只是负荷剂量为70 ml（而非30 ml）。

结果

在轻度中毒患者中，尽管方案II中ASV的平均需求量（仅为128.6 ml）与方案I（137.5 ml）相比略低，但方案I中有1例患者出现凝血功能障碍复发。在中度中毒患者中，方案II和方案III中ASV的平均需求量分别为221.3 ml和179 ml，远低于方案I（343.8 ml）（p值分别为0.05和0.01）。此外，接受方案III的患者无凝血功能障碍复发。在重度中毒患者中，方案II和方案III所需ASV的平均剂量几乎相似，分别为213.7 ml和233.7 ml，而方案I需要剂量为433.3 ml（p值分别为0.02和0.001）。然而，方案III中CT恢复正常的时间仅为18小时，而方案I和方案II分别为23.6小时和24小时。