Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
Department of Emergency Medicine, Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea.
Clin Toxicol (Phila). 2021 Apr;59(4):286-295. doi: 10.1080/15563650.2020.1802473. Epub 2020 Aug 25.
This study investigated the incidence, progression and clinical course of myocardial injury-related snake envenomation in South Korea. In addition, this study evaluated whether antivenom guidelines are appropriate to control envenomation in patients with myocardial injury.
The study included 198 patients who received antivenom after a snakebite, and they were divided into two groups according to evidence of myocardial injury (defined as elevated troponin I or ischemic change on electrocardiogram) at presentation. Data including serial troponin I, echocardiogram/coronary angiogram findings, the clinical course, and treatment were collected and analyzed.
The incidence of myocardial injury at presentation was 15.2%. The troponin I level was 0.11 (0.07-0.56) ng/ml at presentation and tended to decrease over 24 h. Echocardiograms revealed neither regional wall motion abnormalities nor left ventricular dysfunction in 15 of 17 patients, while two patients showed signs of coronary artery stenosis on echocardiograms and coronary angiograms. However, compared with patients without myocardial injury, patients with myocardial injury had a higher frequency of systemic envenomation complications, including bleeding, respiratory failure, hypotension, acute kidney injury, thrombocytopenia and venom-induced consumption coagulopathy (VICC). The patients with myocardial injury at presentation needed significantly more frequent and larger doses of antivenom than indicated by the initial severity of envenomation. Multivariate analysis showed that myocardial injury was associated with the need for additional antivenom administration after initial administration.
Myocardial injury is not uncommon after snake envenomation in Korea. Although myocardial injury itself seems to be benign, the clinical course of patients with myocardial injury is complicated, and myocardial injury is associated with the need for additional antivenom administration. The optimal use of antivenom to control envenomation in patents with myocardial injury after snake envenomation in South Korea should be established.
本研究调查了韩国蛇伤相关心肌损伤的发生率、进展和临床过程。此外，本研究还评估了抗蛇毒血清指南是否适合控制心肌损伤患者的蛇伤。
该研究纳入了 198 例接受抗蛇毒血清治疗的蛇伤患者，根据就诊时是否存在心肌损伤证据（定义为肌钙蛋白 I 升高或心电图上的缺血改变）将其分为两组。收集并分析了包括连续肌钙蛋白 I、超声心动图/冠状动脉造影结果、临床过程和治疗在内的数据。
就诊时心肌损伤的发生率为 15.2%。就诊时肌钙蛋白 I 水平为 0.11（0.07-0.56）ng/ml，24 小时内呈下降趋势。17 例患者中，15 例超声心动图未见局部壁运动异常或左心室功能障碍，2 例患者超声心动图和冠状动脉造影显示存在冠状动脉狭窄迹象。然而，与无心肌损伤的患者相比，有心肌损伤的患者更常出现全身性蛇伤并发症，包括出血、呼吸衰竭、低血压、急性肾损伤、血小板减少和蛇毒诱导的消耗性凝血病（VICC）。就诊时存在心肌损伤的患者需要比初始蛇伤严重程度所建议的更频繁和更大剂量的抗蛇毒血清。多变量分析显示，心肌损伤与初始治疗后需要额外给予抗蛇毒血清有关。
韩国蛇伤后心肌损伤并不少见。尽管心肌损伤本身似乎是良性的，但有心肌损伤患者的临床过程较为复杂，且心肌损伤与需要额外给予抗蛇毒血清有关。应确定在韩国蛇伤后出现心肌损伤的患者中，如何最佳使用抗蛇毒血清来控制蛇伤。
