Ryan Nicole M, Buckley Nicholas A, Graudins Andis
Clinical Toxicology Research Group, School of Medicine and Public Health, The University of Newcastle, Newcastle 2298, Australia.
Sydney Medical School, University of Sydney, Sydney 2006, Australia.
Toxins (Basel). 2017 Apr 21;9(4):148. doi: 10.3390/toxins9040148.
Latrodectism or envenomation by widow-spiders is common and clinically significant worldwide. Alpha-latrotoxin is the mammalian-specific toxin in the venom that results in toxic effects observed in humans. Symptoms may be incapacitating and include severe pain that can persist for days. The management of mild to moderate latrodectism is primarily supportive while severe cases have variously been treated with intravenous calcium, muscle relaxants, widow-spider antivenom and analgesic opioids. The object of this systematic review is to examine the literature on the clinical effectiveness of past and current treatments for latrodectism. MEDLINE, EMBASE and Google Scholar were searched from 1946 to December 2016 to identify clinical studies on the treatment of latrodectism. Studies older than 40 years and not in English were not reviewed. There were only two full-publications and one abstract of placebo-controlled randomised trials on antivenom use for latrodectism. Another two randomised comparative trials compared the route of administration of antivenom for latrodectism. There were fourteen case series (including two abstracts), fourteen case reports and one letter investigating drug treatments for latrodectism with the majority of these also including antivenom for severe latrodectism. Antivenom with opioid analgesia is often the major treatment reported for latrodectism however; recent high quality evidence has cast doubt on the clinical effectiveness of this combination and suggests that other treatments need to be investigated.
全球范围内，被寡妇蜘蛛蜇伤或中毒很常见且具有临床重要性。α- 蛛毒素是该毒液中对哺乳动物特异的毒素，可导致人类出现中毒效应。症状可能使人丧失能力，包括可持续数天的剧痛。轻度至中度蛛咬伤的处理主要是支持性治疗，而严重病例则分别采用静脉注射钙剂、肌肉松弛剂、寡妇蜘蛛抗蛇毒血清和止痛类阿片进行治疗。本系统评价的目的是研究过去和当前治疗蛛咬伤的临床疗效的相关文献。检索了1946年至2016年12月期间的MEDLINE、EMBASE和谷歌学术，以确定关于蛛咬伤治疗的临床研究。未纳入40年以上且非英文的研究。关于抗蛇毒血清用于蛛咬伤治疗的安慰剂对照随机试验仅有两篇全文发表文章和一篇摘要。另外两项随机对照试验比较了蛛咬伤抗蛇毒血清的给药途径。有十四篇病例系列（包括两篇摘要）、十四篇病例报告和一篇信函探讨了蛛咬伤的药物治疗，其中大多数也包括用于严重蛛咬伤的抗蛇毒血清。然而，抗蛇毒血清联合阿片类镇痛药物常常是报道的蛛咬伤主要治疗方法；最近的高质量证据对这种联合治疗的临床疗效提出了质疑，并表明需要研究其他治疗方法。
