Chiang Liao-Chun, Tsai Wei-Jen, Liu Po-Yu, Ho Cheng-Hsuan, Su Hung-Yuan, Lai Chih-Sheng, Lai Kuo-Lung, Lin Wen-Loung, Lee Chi-Hsin, Yang Yi-Yuan, Doan Uyen Vy, Maharani Tri, Mao Yan-Chiao
National Tsing Hua University, College of Life Sciences, Hsinchu, Taiwan.
School of Medicine, National Defense Medical Center, Taipei, Taiwan.
J Venom Anim Toxins Incl Trop Dis. 2020 Sep 18;26:e20200043. doi: 10.1590/1678-9199-JVATITD-2020-0043.
bite induces tissue swelling, pain, thrombocytopenia, rhabdomyolysis, and acute renal failure. However, the incidence of coagulopathy, factors associated with wound necrosis, and the appropriate management of this condition have not been well characterized yet.
This study included patients bitten by . . that were admitted to the study hospitals from 2001 to 2016. Patient characteristics, laboratory data, and management approaches were compared in victims with and without wound necrosis.
A total of 185 patients were evaluated: three patients (1.6%) were asymptomatic; whereas tissue swelling and pain, local ecchymosis, wound necrosis, coagulopathy, thrombocytopenia, rhabdomyolysis, and renal impairment were present in 182, 53, 13, 15, 10, 1, and 3 patients, respectively. One patient died from coagulopathy and hemorrhagic shock. Antivenom was administered to all envenomed patients at a median time of 1.8 h after the bite. The median total dose of antivenom was five vials. Chi-square analysis showed that bitten fingers, using cold packs during first aid, presence of bullae or blisters, lymphangitis or lymphadenitis, local numbness and suspected infection to be significantly associated with wound necrosis. After adjustment using a multivariate logistic regression model, only cold packs as first aid, bulla or blister formation, and wound infection remained significant.
The main effects of . . envenomation are tissue swelling, pain, and local ecchymosis. We do not recommend the use of cold packs during first aid to reduce wound pain, as this may be a risk factor for wound necrosis. In addition, patients with bulla or blister formation should be carefully examined for subsequent wound necrosis. Antiplatelet use may worsen systemic bleeding. No severe rhabdomyolysis or renal failure was observed in this large case series, we therefore considered that they were not prominent effects of . . bite.
咬伤可导致组织肿胀、疼痛、血小板减少、横纹肌溶解和急性肾衰竭。然而，凝血病的发生率、与伤口坏死相关的因素以及该病症的适当治疗方法尚未得到充分阐明。
本研究纳入了2001年至2016年期间被……咬伤并入住研究医院的患者。对有伤口坏死和无伤口坏死的受害者的患者特征、实验室数据和治疗方法进行了比较。
共评估了185例患者：3例（1.6%）无症状；而182例、53例、13例、15例、10例、1例和3例患者分别出现组织肿胀和疼痛、局部瘀斑、伤口坏死、凝血病、血小板减少、横纹肌溶解和肾功能损害。1例患者死于凝血病和失血性休克。所有中毒患者在咬伤后中位时间1.8小时接受抗蛇毒血清治疗。抗蛇毒血清的中位总剂量为5瓶。卡方分析显示，被咬伤手指、急救时使用冷敷、出现大疱或水疱、淋巴管炎或淋巴结炎、局部麻木和疑似感染与伤口坏死显著相关。使用多因素逻辑回归模型进行调整后，只有急救时使用冷敷、大疱或水疱形成以及伤口感染仍然显著。
……中毒的主要影响是组织肿胀、疼痛和局部瘀斑。我们不建议在急救时使用冷敷来减轻伤口疼痛，因为这可能是伤口坏死的危险因素。此外，对于出现大疱或水疱的患者，应仔细检查是否随后发生伤口坏死。使用抗血小板药物可能会加重全身出血。在这个大型病例系列中未观察到严重的横纹肌溶解或肾衰竭，因此我们认为它们不是……咬伤的突出影响。
