Emergency Medical Center, Kagawa University Hospital, Toru Hifumi, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793 Japan.
Japan Snake Institute, 3318 Yabutsuka, Ota, Gunma, 379-2301 Japan.
J Intensive Care. 2014 Mar 6;2(1):19. doi: 10.1186/2052-0492-2-19. eCollection 2014.
Yamakagashi (Rhabdophis tigrinus) is a species of pit viper present throughout Russia and Eastern Asia. Although R. tigrinus venom is known to induce life-threatening hemorrhagic symptoms, the clinical characteristics and effective treatment of R. tigrinus bites remain unknown. The present study aimed to clarify these issues.
Records in the Japan Snake Institute between 2000 and 2013 were retrospectively investigated. The following were determined: patient characteristics, coagulation and fibrinolytic system abnormalities, effect of antivenom treatment, and outcomes.
Nine patients (all males; median age, 38 years) with R. tigrinus bites were identified. On admission, the median levels of fibrinogen and fibrinogen degradation products, and platelet counts were 50 mg/dL, 295 μg/mL, and 107,000/mm(3), respectively. The median (minimum-maximum) disseminated intravascular coagulation (DIC) score defined by the Japanese Association of Acute Medicine was 8 (1-8). Antivenom was administered to seven patients, with a median interval of 35 h between bite and antivenom administration. All patients treated with antivenom survived, and the in-hospital mortality rate was 11%.
Patients with R. tigrinus bites presented with DIC of a fibrinolytic phenotype, which can result in life-threatening injury unless appropriate antivenom and DIC treatment are provided.
虎斑颈槽蛇（Rhabdophis tigrinus）分布于俄罗斯和东亚地区。虽然已知虎斑颈槽蛇的毒液会引起危及生命的出血症状，但有关该蛇咬伤的临床特征和有效治疗方法仍不清楚。本研究旨在阐明这些问题。
回顾性调查了日本蛇类研究所 2000 年至 2013 年的记录。确定了以下内容：患者特征、凝血和纤维蛋白溶解系统异常、抗蛇毒血清治疗效果和结局。
确定了 9 例（均为男性；中位年龄 38 岁）虎斑颈槽蛇咬伤患者。入院时，纤维蛋白原和纤维蛋白原降解产物以及血小板计数的中位数分别为 50mg/dL、295μg/mL 和 107,000/mm³。日本急性医学协会定义的弥散性血管内凝血（DIC）评分中位数（最小-最大值）为 8（1-8）。7 例患者给予抗蛇毒血清治疗，咬伤至抗蛇毒血清治疗的中位时间间隔为 35 小时。所有接受抗蛇毒血清治疗的患者均存活，院内死亡率为 11%。
虎斑颈槽蛇咬伤患者表现出纤维蛋白溶解表型的 DIC，如果不给予适当的抗蛇毒血清和 DIC 治疗，可能会导致危及生命的损伤。
