Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Jawaharlal institute of postgraduate medical education and research, Puducherry, India.
J Forensic Leg Med. 2020 Jul;73:101996. doi: 10.1016/j.jflm.2020.101996. Epub 2020 Jun 9.
The dose of Anti Snake Venom (ASV) in hemotoxic snake bite depends on the amount of venom injected and species of snake. All trials in South East Asia have studied different doses of ASV, wherein the ASV in high dose group itself was lower than the dose that is recommended in Indian National protocol. These studies favored low dose protocol, as there was no difference in mortality and morbidity between the groups. So, this study intended to assess the efficacy of National protocol in reducing morbidity and mortality in hemotoxic snake bite in comparison to current protocol followed in institution. This was an open label randomized trial of 140 hemotoxic snakebite patients. Group A received national protocol: initial dose of 100 ml followed by 100 ml 6th hourly till 20-min Whole Blood Clotting Time (20WBCT) was negative or 300 ml of ASV was given, whichever was earlier. Group B received 70 ml followed by 30 ml every 6th hourly until two consecutive 20WBCT were negative. There was no statistical difference in the amount of ASV required in both the groups. Mortality and acute kidney injury were higher in group A (statistically not significant), probably due to sicker patients in that group. There was no relapse of clotting time abnormality in both the groups. In a significant number of patients (12%), clotting time was persistently prolonged till death. We found that the use of National ASV dosing protocol did not decrease the mortality and morbidity.
抗蛇毒血清（ASV）在血液毒素性蛇咬伤中的剂量取决于注入的毒液量和蛇的种类。东南亚的所有试验都研究了不同剂量的 ASV，其中高剂量组的 ASV 本身低于印度国家方案建议的剂量。这些研究赞成低剂量方案，因为两组之间的死亡率和发病率没有差异。因此，本研究旨在评估国家方案在降低血液毒素性蛇咬伤的发病率和死亡率方面与机构目前遵循的方案相比的疗效。这是一项对 140 例血液毒素性蛇咬伤患者进行的开放性标签随机试验。A 组接受国家方案：初始剂量为 100ml，然后每 6 小时给予 100ml，直到 20 分钟全血凝固时间（20WBCT）为阴性，或给予 300ml ASV，以先发生者为准。B 组接受 70ml，然后每 6 小时给予 30ml，直到连续两次 20WBCT 为阴性。两组所需 ASV 量无统计学差异。A 组死亡率和急性肾损伤较高（统计学无显著差异），可能是由于该组患者病情较重。两组均未出现凝血时间异常复发。在相当数量的患者（12%）中，凝血时间持续延长直至死亡。我们发现，使用国家 ASV 剂量方案并没有降低死亡率和发病率。
