Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki Kita, Kagawa 761-0793 Japan.
The Japan Snake Institute, Yabutsuka 3318, Ota Gumma, 379-2301 Japan.
J Intensive Care. 2014 Jul 31;2(1):44. doi: 10.1186/s40560-014-0044-5. eCollection 2014.
Rhabdophis tigrinus (Yamakagashi snake) is a rear-fanged colubrid snake present throughout Russia and Asia. Its venom induces life-threatening hemorrhagic symptoms and severe disseminated intravascular coagulation with a fibrinolytic phenotype. R. tigrinus antivenom manufactured by the immunization of horses to neutralize the venom has the risk of adverse events such as anaphylaxis and serum sickness disease. It should be used when benefit is greater than the risk of adverse effects; however, its efficacy has not been well evaluated. Although our previous survey of nine cases demonstrated that seven of all cases treated with antivenom survived, the clinical characteristics and prognosis without antivenom administration remained unclear. We assumed that R. tigrinus antivenom administration overlaps self-recovery with supportive care. We aimed to determine the association between antivenom administration and outcome with further analyzed cases.
We retrospectively reviewed the records of the Japan Snake Institute between January 1, 1973 and December 31, 2013. Antivenom and without antivenom groups were compared with regard to baseline demographic features, treatment-related factors, and outcomes.
In total, 34 patients were analyzed (97% male, median age 37.5 years). Twenty-five patients were further examined from our previous study. On admission, the median levels of fibrinogen and fibrinogen degradation products were 35 mg/dL and 200 μg/mL, respectively, and platelet counts were 107,000/mm(3). The median disseminated intravascular coagulation score (defined by the Japanese Association of Acute Medicine) was 5. Antivenom was administered to 19 patients, with a median interval of 32 h between bite and antivenom administration. The in-hospital mortality rate was 12%. In univariate analysis, baseline characteristics and laboratory data were not significantly different between the antivenom and without antivenom groups. Hospital mortality in the antivenom group was significantly better than that in the without antivenom group (0% vs. 26.7%, P = 0.03). Moreover, the number of patients developing renal failure requiring hemodialysis was significantly lower in the antivenom group (5.3% vs. 40.0%, P = 0.03).
In our small retrospective study, antivenom administration was likely to be effective in the management of R. tigrinus bites. Apparently, further research is required to confirm its efficacy.
虎斑颈槽蛇（Yamakagashi 蛇）是一种后沟牙游蛇，分布于俄罗斯和亚洲各地。其毒液可引起危及生命的出血症状和严重弥漫性血管内凝血，并伴有纤维蛋白溶解表型。用马免疫制备的抗虎斑颈槽蛇蛇毒血清用于中和毒液，有发生过敏反应和血清病等不良反应的风险。只有当益处大于不良反应的风险时才应使用；然而，其疗效尚未得到很好的评估。尽管我们之前对 9 例病例的调查表明，所有接受抗蛇毒血清治疗的病例中有 7 例存活，但未使用抗蛇毒血清治疗的临床特征和预后仍不清楚。我们假设抗蛇毒血清的使用与支持性治疗的自我恢复重叠。我们旨在通过进一步分析病例来确定抗蛇毒血清的使用与结果之间的关联。
我们回顾性分析了 1973 年 1 月 1 日至 2013 年 12 月 31 日期间日本蛇类研究所的记录。比较了抗蛇毒血清组和非抗蛇毒血清组在基线人口统计学特征、治疗相关因素和结局方面的差异。
共分析了 34 例患者（97%为男性，中位年龄 37.5 岁）。25 例患者来自我们之前的研究。入院时，纤维蛋白原和纤维蛋白原降解产物的中位数分别为 35mg/dL 和 200μg/mL，血小板计数为 107,000/mm(3)。日本急性医学协会定义的弥散性血管内凝血评分中位数为 5 分。19 名患者接受了抗蛇毒血清治疗，从咬伤到抗蛇毒血清治疗的中位间隔时间为 32 小时。住院死亡率为 12%。在单因素分析中，抗蛇毒血清组和非抗蛇毒血清组的基线特征和实验室数据无显著差异。抗蛇毒血清组的住院死亡率明显优于非抗蛇毒血清组（0% vs. 26.7%，P=0.03）。此外，抗蛇毒血清组需要血液透析的肾衰竭患者人数明显低于非抗蛇毒血清组（5.3% vs. 40.0%，P=0.03）。
在我们的小回顾性研究中，抗蛇毒血清治疗可能对虎斑颈槽蛇咬伤的治疗有效。显然，需要进一步的研究来证实其疗效。
