一例因虎斑颈槽蛇（虎斑游蛇）咬伤导致严重凝血障碍的创伤性脑损伤致死病例报告
A fatal case of traumatic brain injury with severe coagulopathy due to Rhabdophis tigrinus (yamakagashi) bites: a case report.
作者信息
Ueno Daisuke, Yasukazu Shiino, Takahashi Jiro, Miyamoto Satomi, Inoue Takahiro
机构信息
Department of Acute Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
出版信息
Int J Emerg Med. 2021 Dec 20;14(1):77. doi: 10.1186/s12245-021-00402-4.
BACKGROUND
Yamakagashi venom is a prothrombin activator, leading to disseminated intravascular coagulation. We report a fatal case of severe coagulopathy from head trauma assumed to be caused by a yamakagashi bite.
CASE PRESENTATION
An 80-year-old man fell and developed systemic tonic-clonic convulsions. Head computed tomography revealed brain contusion and acute subdural hematoma. Physical examination revealed two bite marks with persistent bleeding on the right lower leg. The patient stated that he had been bitten by some creature 3 days prior, but the bite was left untreated. Laboratory tests showed fibrinogen levels below the detection limit. Although eighteen units of fresh frozen plasma were administered for coagulopathy, fibrinogen levels did not improve. He died about 18 h after a head injury.
CONCLUSION
In this case of a yamakagashi bite with active bleeding due to trauma, early administration of yamakagashi antivenom should be considered to control coagulopathy.
背景
山烙铁头蛇毒液是一种凝血酶原激活剂，可导致弥散性血管内凝血。我们报告一例因头部外伤导致严重凝血病的致命病例，推测是由山烙铁头蛇咬伤所致。
病例介绍
一名80岁男性摔倒后出现全身性强直阵挛性惊厥。头部计算机断层扫描显示脑挫伤和急性硬膜下血肿。体格检查发现右小腿有两处咬痕且持续出血。患者称3天前被某种生物咬伤，但未对咬伤进行处理。实验室检查显示纤维蛋白原水平低于检测限。尽管因凝血病输注了18单位新鲜冰冻血浆，但纤维蛋白原水平并未改善。他在头部受伤后约18小时死亡。
结论
在这例因山烙铁头蛇咬伤且伴有创伤性活动性出血的病例中，应考虑早期给予山烙铁头蛇抗蛇毒血清以控制凝血病。
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