NSW Poisons Information Centre, Sydney Children's Hospitals Network, Sydney, NSW
University of Newcastle, Newcastle, NSW.
Med J Aust. 2017 Aug 7;207(3):119-125. doi: 10.5694/mja17.00094.
To describe the epidemiology, treatment and adverse events after snakebite in Australia.
Prospective, multicentre study of data on patients with snakebites recruited to the Australian Snakebite Project (2005-2015) and data from the National Coronial Information System. Setting, participants: Patients presenting to Australian hospitals with suspected or confirmed snakebites from July 2005 to June 2015 and consenting to participation.
Demographic data, circumstances of bites, clinical effects of envenoming, results of laboratory investigations and snake venom detection kit (SVDK) testing, antivenom treatment and adverse reactions, time to discharge, deaths.
1548 patients with suspected snakebites were enrolled, including 835 envenomed patients (median, 87 per year), for 718 of which the snake type was definitively established, most frequently brown snakes (41%), tiger snakes (17%) and red-bellied black snakes (16%). Clinical effects included venom-induced consumption coagulopathy (73%), myotoxicity (17%), and acute kidney injury (12%); severe complications included cardiac arrest (25 cases; 2.9%) and major haemorrhage (13 cases; 1.6%). There were 23 deaths (median, two per year), attributed to brown (17), tiger (four) and unknown (two) snakes; ten followed out-of-hospital cardiac arrests and six followed intracranial haemorrhages. Of 597 SVDK test results for envenomed patients with confirmed snake type, 29 (4.9%) were incorrect; 133 of 364 SVDK test results for non-envenomed patients (36%) were false positives. 755 patients received antivenom, including 49 non-envenomed patients; 178 (24%), including ten non-envenomed patients, had systemic hypersensitivity reactions, of which 45 (6%) were severe (hypotension, hypoxaemia). Median total antivenom dose declined from four vials to one, but median time to first antivenom was unchanged (4.3 hours; IQR, 2.7-6.3 hours).
Snake envenoming is uncommon in Australia, but is often severe. SVDKs were unreliable for determining snake type. The median antivenom dose has declined without harming patients. Improved early diagnostic strategies are needed to reduce the frequently long delays before antivenom administration.
描述澳大利亚蛇伤的流行病学、治疗和不良事件。
对 2005 年 7 月至 2015 年 6 月期间在澳大利亚医院就诊的疑似或确诊蛇伤患者进行澳大利亚蛇伤项目（Australian Snakebite Project）的前瞻性多中心研究数据和国家验尸信息系统（National Coronial Information System）数据的收集。
地点、参与者：纳入 2005 年 7 月至 2015 年 6 月期间在澳大利亚医院就诊的疑似蛇伤患者，并同意参与。
人口统计学数据、咬伤情况、蛇毒中毒的临床影响、实验室检查和蛇毒检测试剂盒（SVDK）检测结果、抗蛇毒血清治疗和不良反应、出院时间、死亡。
共纳入 1548 例疑似蛇伤患者，其中 835 例蛇伤患者（中位数每年 87 例），其中 718 例明确蛇种，最常见的蛇种为棕色蛇（41%）、虎蛇（17%）和红腹黑蛇（16%）。临床影响包括蛇毒诱导的消耗性凝血障碍（73%）、肌毒性（17%）和急性肾损伤（12%）；严重并发症包括心脏骤停（25 例；2.9%）和大出血（13 例；1.6%）。有 23 例死亡（中位数每年 2 例），归因于棕色蛇（17 例）、虎蛇（4 例）和未知蛇（2 例）；10 例死亡发生在院外心脏骤停后，6 例发生在颅内出血后。597 例蛇伤患者的 SVDK 检测结果中，29 例（4.9%）不正确；364 例非蛇伤患者的 SVDK 检测结果中，133 例（36%）为假阳性。755 例患者接受了抗蛇毒血清治疗，其中 49 例为非蛇伤患者；178 例（24%），包括 10 例非蛇伤患者，发生全身过敏反应，其中 45 例（6%）为严重（低血压、低氧血症）。抗蛇毒血清总剂量中位数从四瓶降至一瓶，但首次使用抗蛇毒血清的时间中位数保持不变（4.3 小时；IQR，2.7-6.3 小时）。
蛇伤在澳大利亚并不常见，但通常较为严重。SVDK 试剂盒对于确定蛇的种类不可靠。抗蛇毒血清的中位剂量有所下降，但并未对患者造成伤害。需要改进早期诊断策略，以减少在使用抗蛇毒血清前经常出现的长时间延迟。
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