肿胀抗蛇毒血清：抗 Naja naja 神经毒性蛇咬伤的院前治疗的鼠模型。

Tumescent contravenom: murine model for prehospital treatment of Naja naja neurotoxic snake envenomation.

机构信息

Department of Dermatology, University of California, Irvine, Irvine, CA, USA.

Union College, Schenectady, NY, USA.

出版信息

Int J Dermatol. 2018 May;57(5):605-610. doi: 10.1111/ijd.13877. Epub 2018 Feb 20.

DOI:10.1111/ijd.13877

PMID:29460967

Abstract

BACKGROUND

Snake envenomation is a neglected global health problem. There is a need for a prehospital treatment of neurotoxic snakebite that prolongs survival and allows time for a victim to reach a hospital for antivenom therapy. Tumescent epinephrine consists of a large volume of dilute epinephrine (2 mg/l) injected subcutaneously. It functions as "contravenom" by causing capillary vasoconstriction and delaying venom absorption.

METHODS

A murine model of neurotoxic envenomation using lidocaine as a surrogate for neurotoxic snake venom was first developed in a pilot study. A lethal dose of lidocaine was injected subcutaneously into control and treatment groups. Mice in the treatment group were then treated with a tumescent infiltration of dilute epinephrine in saline, while control mice either received no treatment or tumescent infiltration with saline alone. The experiment was repeated using lethal doses of neurotoxic Naja naja cobra venom. The main end-points were survival rate and survival time.

RESULTS

None of the control mice survived a lethal (LD ) dosage of subcutaneous lidocaine. Mice given an LD of subcutaneous lidocaine and treated immediately with tumescent epinephrine had 80% survival. Following LD doses of Naja naja venom, 50% of control mice survived, while 94% survived when treated immediately with tumescent epinephrine (P < 0.01). All animals died following LD doses of Naja naja venom, but survival was significantly prolonged (P < 0.0001) by immediate tumescent epinephrine.

CONCLUSIONS

Tumescent epinephrine, when given immediately after toxin injection, improves survival rates in mice following neurotoxic doses of lidocaine or Naja naja cobra venom.

摘要

背景

蛇咬伤是一个被忽视的全球健康问题。需要一种院前治疗神经毒性蛇咬伤的方法，这种方法可以延长患者的生存时间，使其有时间到达医院接受抗蛇毒血清治疗。肿胀型肾上腺素由大体积的稀释肾上腺素（2 毫克/升）皮下注射组成。它通过引起毛细血管收缩和延迟毒液吸收而起“抗毒液”作用。

方法

首先在一项初步研究中，使用利多卡因作为神经毒性蛇毒的替代物，建立了神经毒性蛇咬伤的鼠模型。在对照组和治疗组中，皮下注射致死剂量的利多卡因。然后，治疗组的小鼠接受肿胀型生理盐水稀释肾上腺素浸润治疗，而对照组小鼠接受生理盐水浸润或不接受任何治疗。使用致死剂量的神经毒性眼镜蛇毒液重复进行实验。主要终点是存活率和生存时间。

结果

没有一只对照组的小鼠能在皮下注射致死剂量（LD）利多卡因的情况下存活。给予 LD 剂量的皮下利多卡因并立即用肿胀型肾上腺素治疗的小鼠有 80%的存活率。给予 LD 剂量的眼镜蛇毒液后，对照组有 50%的小鼠存活，而立即用肿胀型肾上腺素治疗的小鼠有 94%的存活率（P < 0.01）。所有动物在 LD 剂量的眼镜蛇毒液后均死亡，但立即使用肿胀型肾上腺素可显著延长存活时间（P < 0.0001）。