Darracq Michael A, Cantrell F Lee, Klauk Bryan, Thornton Stephen L
University of California, San Francisco (UCSF) Fresno Medical Education Program, Department of Emergency Medicine, 155N. Fresno Street, Fresno, CA 93701, USA.
California Poison Control System-San Diego Division, University of California San Francisco, University of California San Diego Department of Emergency Medicine, San Diego, CA, USA.
Toxicon. 2015 Jul;101:23-6. doi: 10.1016/j.toxicon.2015.04.014. Epub 2015 Apr 29.
Fasciotomy has been described in the treatment of rattlesnake-envenomation. We sought to compare the characteristics of patients undergoing fasciotomy with those where fasciotomy was discussed but not performed.
A retrospective case-series constructed from a single-statewide-poison-system electronic database for cases of fasciotomy discussion or completion in rattlesnake-envenomation between January 2001 and May 2012. Age, gender, bite location, antivenom administered, compartment pressure measurements, Snakebite Severity Score (SSS) and length of hospitalization (LOS) were recorded. Comparisons were made between fasciotomy completed and where fasciotomy was only discussed.
One-hundred-five cases of fasciotomy discussion or completion were identified. Fasciotomy was performed in 28 cases (27%). There was no statistically significant difference (p > 0.05) between groups in age, gender, bite site, SSS, and total number of vials of antivenom administered. Only 2 of 28 (7%) had compartment pressure measurements. Patients undergoing fasciotomy spent an additional 2 days in the hospital.
Fasciotomies continue to take place, without compartment pressure measurements, and without repeat dosing of antivenom. In the absence of clear objective evidence that limb-threatening compartment syndrome occurs despite adequate antivenom administration, fasciotomy does not favorably impact morbidity and may be associated with increased costs for care following rattlesnake envenomation.
切开筋膜减压术已被用于治疗响尾蛇咬伤中毒。我们试图比较接受切开筋膜减压术的患者与那些讨论过但未进行该手术的患者的特征。
从一个全州范围的单一毒物系统电子数据库中构建回顾性病例系列，纳入2001年1月至2012年5月期间因响尾蛇咬伤中毒而讨论或完成切开筋膜减压术的病例。记录年龄、性别、咬伤部位、使用的抗蛇毒血清、肌间隔压力测量值、蛇咬伤严重程度评分（SSS）和住院时间（LOS）。对完成切开筋膜减压术的患者和仅讨论过该手术的患者进行比较。
共识别出105例切开筋膜减压术讨论或完成的病例。28例（27%）进行了切开筋膜减压术。两组在年龄、性别、咬伤部位、SSS以及抗蛇毒血清使用瓶数方面无统计学显著差异（p>0.05）。28例中只有2例（7%）进行了肌间隔压力测量。接受切开筋膜减压术的患者住院时间额外增加了2天。
切开筋膜减压术仍在进行，未进行肌间隔压力测量，也未重复使用抗蛇毒血清。在没有明确客观证据表明尽管给予了足够的抗蛇毒血清仍发生威胁肢体的骨筋膜室综合征的情况下，切开筋膜减压术对发病率没有积极影响，且可能与响尾蛇咬伤中毒后的护理费用增加有关。
