台湾地区眼镜蛇咬伤致眼炎的流行病学调查：1990 年至 2016 年的研究。
Naja atra venom-spit ophthalmia in Taiwan: An epidemiological survey from 1990 to 2016.
机构信息
Institute of Emergency and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
Department of Emergency, Taichung Armed Forces General Hospital, Taichung, Taiwan, ROC.
出版信息
J Chin Med Assoc. 2020 Jan;83(1):77-83. doi: 10.1097/JCMA.0000000000000223.
BACKGROUND
Venomous snakebites are common during hot seasons in Taiwan. However, rarely is venom spat directly into the subject's eyes, causing eye injury. Despite being uncommon, analytical data regarding venom-spit ophthalmia in Taiwan have been lacking. This study thus aimed to conduct an epidemiological survey on Naja atra venom-spit ophthalmia in Taiwan during the past decades to improve future care of such patients.
METHODS
Registered records of cases with snake venom injuries at the Taiwan National Poison Control Center from 1990 to 2016 were retrospectively reviewed, enrolling those with records of cobra venom-spit eye injuries and excluding exotic species. Demographic data, clinical symptoms, snake species, ocular conditions, management, and outcomes were recorded and analyzed.
RESULTS
A total of 39 cases suffering from Naja atra venom-spit ophthalmia were enrolled. The overall incidence rate was 1.6 cases per million people from 1990 to 2016. Among the included cases, most were unilaterally injured (82%), male (95%), aged 18 to 59 years (90%), injured during catching (51%), and injured in spring and summer (92%). Ocular symptoms occurred in 90% of the cases, majority of which included ocular pain (90%) and redness (85%). Conjunctivitis (67%) and corneal injury (59%) of involved eyes were common. Immediate water irrigations were done in all cases, most of whom received further topical eye drops, including antibiotics, corticosteroids, and vasoconstrictors. Although topical or intravenous antivenoms were administered in 11 cases, no obviously superior outcome was observed. Most cases (77%) were symptom free after the acute stage.
CONCLUSION
Although Naja atra venom-spit ophthalmia in Taiwan is uncommon, the risk for transient ocular symptoms and corneal/conjunctival injury does exists. Prompt ocular irrigation and professional ophthalmic care after envenomation help prevent serious ocular sequelae. Moreover, superior outcomes were not achieved with the use of antivenom. Nonetheless, further studies are required to clarify the role antivenoms play in venom-spit ophthalmia.
背景
在台湾的炎热季节，毒蛇咬伤很常见。然而，毒液很少会直接喷到受害者的眼睛里，导致眼部受伤。尽管这种情况很少见，但台湾关于蛇毒喷溅性眼炎的分析数据一直缺乏。因此，本研究旨在对过去几十年台湾的眼镜蛇毒液喷溅性眼炎进行流行病学调查，以改善此类患者的未来护理。
方法
回顾性分析 1990 年至 2016 年台湾国家中毒控制中心毒蛇咬伤登记记录，纳入有眼镜蛇毒液喷溅眼伤记录且排除外来物种的病例。记录并分析人口统计学数据、临床症状、蛇种、眼部状况、处理方法和结果。
结果
共纳入 39 例被 Naja atra 毒液喷溅致眼炎的患者。1990 年至 2016 年的总体发病率为每百万人 1.6 例。纳入病例中，单侧损伤者占 82%（32/39），男性占 95%（37/39），年龄 18 至 59 岁者占 90%（35/39），在捕捉过程中受伤者占 51%（20/39），春季和夏季受伤者占 92%（36/39）。90%（35/39）的病例出现眼部症状，主要包括眼部疼痛（90%）和眼红（85%）。结膜炎（67%）和角膜损伤（59%）在受累眼中很常见。所有病例均立即进行了水冲洗，其中大多数进一步接受了包括抗生素、皮质类固醇和血管收缩剂在内的局部滴眼剂治疗。尽管有 11 例使用了局部或静脉注射抗蛇毒血清，但并未观察到明显的更好的结果。大多数病例（77%）在急性期后症状消失。
结论
尽管台湾的 Naja atra 毒液喷溅性眼炎并不常见，但确实存在短暂性眼部症状和角膜/结膜炎损伤的风险。毒蛇咬伤后及时进行眼部冲洗和专业的眼科护理有助于预防严重的眼部后遗症。此外，使用抗蛇毒血清并不能取得更好的效果。尽管如此，仍需要进一步的研究来阐明抗蛇毒血清在蛇毒喷溅性眼炎中的作用。
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