a Division of Clinical Toxicology, Department of Emergency Medicine , Taichung Veterans General Hospital , Taichung , Taiwan.
b Division of Clinical Toxicology and Occupational Medicine, Department of Medicine , Taipei Veterans General Hospital , Taipei , Taiwan.
Clin Toxicol (Phila). 2018 Apr;56(4):273-280. doi: 10.1080/15563650.2017.1366502. Epub 2017 Aug 23.
Naja atra snakebite is uncommon in Taiwan and causes distinct effects on its victims. Although the Taiwan government produces its own specific antivenom, little information on the management of N. atra snakebite is available.
We retrospectively evaluated 183 patients admitted to two medical centers. Of these, 45 were identified as definite cases of N. atra snakebite, 86 as suspected cases, and 52 as clinical cases. Demographic data, symptomatology, and management were compared between these case groups.
Symptomatology and management were similar in the three groups. Among the 183 patients, 10 (5.5%) were asymptomatic and nine (4.9%) had transient and partial ptosis or body weakness. The principal effects were local tissue swelling and pain in 173 patients (94.5%), followed by clinically suspected wound infection in 148 (80.9%), skin necrosis in 120 (65.6%), necrotizing soft tissue infection in 77 (42.1%), fever in 59 (32.2%), and gastrointestinal effects in 53 (29%). The median total dose of specific antivenom needed to treat N. atra envenoming was 10 vials. In the envenomed patients, debridement was required in 74 patients (42.8%), fasciotomy/fasciectomy in 46 (26.6%), and finger or toe amputation in seven (4%). The first operation was performed at a median of 3.5 days after the bite.
Based on these typical manifestations, clinical diagnosis of N. atra snakebites may be feasible and practical. In contrast to other snakes of Elapidae family, N. atra bite did not cause serious neurological effects. Early surgical consultation should be obtained because half of the patients underwent surgery due to infectious complications. Acute compartment syndrome was the surgical indication in rare cases; however, overestimation of the incidence may have occurred. This syndrome should be confirmed by serial intracompartmental pressure monitoring instead of only physical examination, and a sufficient dose of antivenom should be given prior to surgical decompression.
在台湾，被尖吻蝮蛇咬伤并不常见，但会对受害者造成明显的影响。尽管台湾政府生产了自己特定的抗蛇毒血清，但关于尖吻蝮蛇咬伤的处理方法的信息却很少。
我们回顾性评估了两家医疗中心收治的 183 名患者。其中，45 例被确定为明确的尖吻蝮蛇咬伤，86 例为疑似病例，52 例为临床病例。比较了这三组病例的人口统计学数据、症状和治疗方法。
三组患者的症状和治疗方法相似。在 183 名患者中，有 10 例（5.5%）无症状，9 例（4.9%）有短暂的部分上睑下垂或肢体无力。主要症状为 173 例（94.5%）局部组织肿胀和疼痛，其次为 148 例（80.9%）临床疑似伤口感染，120 例（65.6%）皮肤坏死，77 例（42.1%）坏死性软组织感染，59 例（32.2%）发热，53 例（29%）胃肠道症状。治疗尖吻蝮蛇咬伤所需的特定抗蛇毒血清总剂量中位数为 10 瓶。在中毒患者中，74 例（42.8%）需要清创，46 例（26.6%）需要筋膜切开/筋膜切除术，7 例（4%）需要手指或脚趾截肢。第一次手术在咬伤后中位数 3.5 天进行。
基于这些典型表现，尖吻蝮蛇咬伤的临床诊断可能是可行和实用的。与其他眼镜蛇科的蛇类不同，尖吻蝮咬伤不会引起严重的神经系统影响。应尽早咨询外科医生，因为一半的患者因感染并发症而行手术治疗。急性筋膜间室综合征是罕见的手术指征；然而，可能存在过度估计的情况。这种综合征应通过连续的筋膜间室压力监测来确认，而不仅仅是体格检查，并且应在进行减压手术前给予足够剂量的抗蛇毒血清。
