Denver Health Hospital Authority, Rocky Mountain Poison and Drug Center, Denver, CO, USA.
Acad Emerg Med. 2011 Jan;18(1):46-52. doi: 10.1111/j.1553-2712.2010.00958.x. Epub 2010 Dec 16.
The prescribing information for Crotalidae Fab antivenom (FabAV) instructs clinicians to administer FabAV until initial control of the envenomation syndrome is achieved. Risk factors for difficulty achieving initial control are not known.
The study aim was to identify factors present before administration of antivenom associated with difficulty achieving initial control.
The authors conducted a retrospective study of all patients presenting to any one of 17 centers and receiving FabAV from 2002 to 2004. Demographic and historical information, as well as data about nine specific venom effects, were collected prior to the administration of antivenom. An expert panel used standard criteria to determine if initial control was achieved. The patient group that had difficulty achieving initial control was compared to the group that achieved initial control, and adjusted odds ratios were calculated using stepwise logistic regression.
A total of 247 patients were included in the final analysis. The majority of patients were envenomated on the upper extremity and were young males. A total of 203 patients (82.2%) achieved initial control. In univariate analysis, thrombocytopenia, bleeding, neurologic effects, and a severe bite were significantly associated with difficulty achieving initial control. After logistic regression, the presence of neurologic effects and thrombocytopenia remained significantly associated with difficulty achieving initial control. When both factors were present, the patient was 13.8 times more likely to have difficulty achieving initial control.
A number of factors were present before the administration of FabAV that were independently associated with difficulty achieving initial control of the envenomation syndrome. Predicting which patients will have difficulty achieving initial control has important ramifications for patient disposition and may provide insight into the mechanisms for lack of antivenom efficacy.
蝮蛇抗蛇毒血清（FabAV）的说明书指示临床医生使用 FabAV，直到达到蛇毒综合征的初步控制。目前尚不清楚达到初步控制的相关危险因素。
本研究旨在确定在使用抗蛇毒血清之前出现的与难以达到初步控制相关的因素。
研究人员对 2002 年至 2004 年在 17 个中心就诊并接受 FabAV 治疗的所有患者进行了回顾性研究。在使用抗蛇毒血清之前收集了人口统计学和病史信息以及有关 9 种特定毒液作用的数据。一个专家小组使用标准标准来确定是否达到了初步控制。将难以达到初步控制的患者组与达到初步控制的患者组进行比较，并使用逐步逻辑回归计算调整后的优势比。
共有 247 名患者纳入最终分析。大多数患者被咬伤在上肢，且为年轻男性。共有 203 名患者（82.2％）达到了初步控制。在单因素分析中，血小板减少症、出血、神经效应和严重咬伤与难以达到初步控制显著相关。在逻辑回归后，神经效应和血小板减少症的存在仍然与难以达到初步控制显著相关。当这两个因素同时存在时，患者达到初步控制的难度是 13.8 倍。
在使用 FabAV 之前，存在许多与难以达到蛇毒综合征初步控制相关的因素。预测哪些患者难以达到初步控制对于患者的处置具有重要意义，并且可能为缺乏抗蛇毒血清疗效的机制提供深入的了解。
