1University of Toyama, Emergency & Disaster Medical Center, Toyama, Japan.
2Toyama Prefectural Central Hospital, Emergency Medical Center, Toyama, Japan.
Am J Trop Med Hyg. 2021 Jun 28;105(2):525-527. doi: 10.4269/ajtmh.21-0291.
Antivenoms are the treatment of choice for managing lethal snakebites. However, antivenoms may not be available in instances where non-native vipers are kept in captivity. We report a case of a puff adder (Bitis arietans) bite treated without antivenom. A 23-year-old man was bitten on his left hand by a puff adder that he illegally kept in his house. The swelling spread rapidly to the upper arm and there was a risk of bleeding, suggesting the need for antivenom administration, but this could not be acquired because of lack of stock. We initiated fluid resuscitation and administered recombinant thrombomodulin (rTM) to prevent venom-induced consumption coagulopathy. In addition, hyperbaric oxygen (HBO) treatment was also performed to reduce local swelling. The patient recovered without complications after the multidisciplinary treatment. Further studies are needed to prove the safety and efficacy of rTM administration and HBO therapy as an adjunct or alternative therapy with antiserum for fatal snakebite.
抗蛇毒血清是治疗致命蛇咬伤的首选药物。然而，在圈养非本地蝰蛇的情况下，可能无法获得抗蛇毒血清。我们报告了一例膨蝰（Bitis arietans）咬伤的病例，该病例未使用抗蛇毒血清进行治疗。一名 23 岁男子被他非法饲养在房子里的膨蝰咬伤左手。肿胀迅速蔓延到上臂，有出血的风险，表明需要使用抗蛇毒血清，但由于库存不足而无法获得。我们开始进行液体复苏，并给予重组血栓调节蛋白（rTM）以预防毒液引起的消耗性凝血病。此外，还进行了高压氧（HBO）治疗以减轻局部肿胀。经过多学科治疗，患者无并发症康复。需要进一步的研究来证明 rTM 给药和 HBO 治疗作为抗血清的辅助或替代疗法治疗致命蛇咬伤的安全性和有效性。
