Division of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Division of Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Clin Toxicol (Phila). 2021 Jan;59(1):28-37. doi: 10.1080/15563650.2020.1762892. Epub 2020 May 13.
bite induces wound necrosis, coagulopathy, thrombocytopenia, rhabdomyolysis, and acute renal failure. The severity of the hematological derangements and associated factors for wound necrosis and subsequent surgery and the appropriate management of these conditions have not been well characterized. Although severe renal failure requiring hemodialysis has been reported following . bite, the culprit snake may be erroneously classified.
A total of 186 patients with . bites were retrospectively evaluated. They were categorized into group 1 (patients receiving debridement or finger/toe amputation) and group 2 (all other patients) to identify the associated factors for surgery. Characteristic data were compared between groups 1 and 2 and between definite and suspected cases.
No differences were observed between definite and suspected cases in terms of symptomatology and management. Of the 186 patients, 7 (3.8%) were asymptomatic, 179 (96.2%) experienced tissue swelling and pain, and 107 (57.5%) had local ecchymosis. Coagulopathy, thrombocytopenia, and renal impairment were found in 13 (7%), 19 (10.2%), and 7 (3.8%) patients, respectively. None of the patients required transfusion therapy or hemodialysis. Furthermore, no systemic bleeding or death occurred. Antivenom was administered to all 179 envenomed patients at a median of 1.5 h post-bite. The median total dose of the specific antivenom was 5.5 vials. In multivariate logistic regression analysis, finger as the bite site, bullae and blister formation, and wound infection were significantly associated with wound necrosis; whereas finger as the bite site and bullae and blister formation were related to debridement or finger/toe amputation.
envenomation mainly exerts effects on local tissue. Systemic effects are uncommon and generally nonsevere and transient after the treatment with the specific antivenom. We speculated that severe renal failure requiring hemodialysis is not a typical finding of . envenomation. Patients with finger as the bite site and bullae or blister formation should be carefully examined for wound necrosis, secondary infection, and subsequent surgery. Further evaluations of the efficacy of antivenom against local tissue effects and the effect of selective antibiotics in the management of bite wound infection are urgently required. Although the antivenom manufacturer suggested a skin test prior to use, we believed that it could be omitted because it does not accurately predict the allergic responses.
咬伤可导致伤口坏死、凝血功能障碍、血小板减少、横纹肌溶解和急性肾衰竭。目前还没有很好地描述血液学紊乱的严重程度及其与伤口坏死和随后手术的相关因素，以及这些情况的适当治疗方法。尽管有报道称，在被. 咬伤后，会出现需要血液透析的严重肾衰竭，但可能错误地对肇事蛇类进行了分类。
回顾性评估了 186 例. 咬伤患者。将他们分为第 1 组（接受清创或指/趾截肢的患者）和第 2 组（所有其他患者），以确定手术的相关因素。比较了第 1 组和第 2 组之间以及确诊病例和疑似病例之间的特征性数据。
在症状和治疗方面，确诊病例和疑似病例之间没有差异。在 186 例患者中，7 例（3.8%）无症状，179 例（96.2%）出现组织肿胀和疼痛，107 例（57.5%）出现局部瘀斑。13 例（7%）出现凝血功能障碍，19 例（10.2%）血小板减少，7 例（3.8%）肾功能损害。没有患者需要输血治疗或血液透析。此外，没有发生全身性出血或死亡。所有 179 例中毒患者在咬伤后中位数 1.5 小时内接受了抗蛇毒血清治疗。特定抗蛇毒血清的中位总剂量为 5.5 瓶。多变量逻辑回归分析显示，咬伤部位为手指、水疱和大疱形成以及伤口感染与伤口坏死显著相关；而咬伤部位为手指和水疱及大疱形成与清创或指/趾截肢有关。
蛇毒主要对局部组织起作用。在使用特定抗蛇毒血清治疗后，全身影响通常不严重且短暂，并不常见。我们推测，需要血液透析的严重肾衰竭并不是. 咬伤的典型表现。咬伤部位为手指和出现水疱或大疱的患者应仔细检查是否发生伤口坏死、继发感染和随后的手术。迫切需要进一步评估抗蛇毒血清对局部组织作用的疗效以及选择性抗生素在处理咬伤伤口感染中的作用。尽管抗蛇毒血清制造商建议在使用前进行皮肤试验，但我们认为可以省略，因为它不能准确预测过敏反应。
