Zengin Suat, Yilmaz Mehmet, Al Behcet, Yildirim Cuma, Yarbil Pinar, Kilic Hasan, Bozkurt Selim, Kose Ataman, Bayraktaroglu Ziya
Gaziantep University School of Medicine, Department of Emergency Medicine, Turkey.
Transfus Apher Sci. 2013 Dec;49(3):494-8. doi: 10.1016/j.transci.2013.03.006. Epub 2013 Mar 30.
Snake bites are leading causes of morbidity and mortality worldwide, especially in rural areas. Therapeutic plasma exchange has been used in the treatment of many different conditions such as immunologic diseases, toxicologic disorders, and snake envenomation. The aim of this study is to evaluate the efficacy of plasma exchange treatment on clinical status, outcomes, and discharge of patients who were bitten by venomous snakes. The study was conducted retrospectively in the Emergency Department of Gaziantep University from January 2002 to December 2011. Thirty-seven patients were included in the present study. Routine biochemical and hematologic laboratory parameters were studied before and after plasma exchange. Demographic data, clinical status, and outcomes of patients were recorded. Plasma exchange was performed by using centrifugation technology via an intravenous antecubital or subclavian vein catheter access. Human albumin/fresh frozen plasma was used as replacement fluids. A significant correlation was seen between therapeutic plasma exchange and improvement of laboratory results. None of the study patients lost their limbs. Eight patients were sent to the intensive care unit. The mean length of the hospital stay was 12.2 days (4-28). All patients were discharged with good recovery. No complications were seen during the 3 months following discharge. Plasma exchange appears to be an effective treatment intervention for snake bite envenomations, especially in the management of hematologic problems and in limb preservation/salvage strategies. In addition to traditional treatment methods, plasma exchange should be considered by emergency physicians in cases of snake bite envenomation as a therapeutic approach to facilitate rapid improvement.
蛇咬伤是全球发病和死亡的主要原因，在农村地区尤为如此。治疗性血浆置换已用于治疗许多不同病症，如免疫性疾病、中毒性疾病和蛇咬伤中毒。本研究的目的是评估血浆置换治疗对被毒蛇咬伤患者的临床状况、治疗结果和出院情况的疗效。本研究于2002年1月至2011年12月在加济安泰普大学急诊科进行回顾性研究。本研究纳入了37例患者。在血浆置换前后研究常规生化和血液学实验室参数。记录患者的人口统计学数据、临床状况和治疗结果。通过静脉肘前或锁骨下静脉导管通路使用离心技术进行血浆置换。使用人白蛋白/新鲜冰冻血浆作为置换液。治疗性血浆置换与实验室结果的改善之间存在显著相关性。本研究中没有患者失去肢体。8例患者被送往重症监护病房。平均住院时间为12.2天（4 - 28天）。所有患者均康复出院。出院后3个月内未出现并发症。血浆置换似乎是治疗蛇咬伤中毒的一种有效治疗干预措施，特别是在血液学问题的管理以及肢体保全/挽救策略方面。除传统治疗方法外，对于蛇咬伤中毒病例，急诊医生应考虑将血浆置换作为一种促进快速康复的治疗方法。
