Department of Surgery, Ngwelezana Hospital, University of KwaZulu-Natal, South Africa.
Department of Surgery, Ngwelezana Hospital, University of KwaZulu-Natal, South Africa.
Toxicon. 2022 Oct 15;217:1-4. doi: 10.1016/j.toxicon.2022.07.008. Epub 2022 Jul 20.
Snakebite victims are commonly seen in KwaZulu-Natal Hospitals, with only a minority of patients requiring antivenom. This study reviewed antivenom-associated adverse events at our institution, after administration of the South African Vaccine Producers (SAVP) polyvalent antivenom.
A retrospective review, over 52 months (January 2016-April 2020), of patients who received antivenom. Demographics, clinical details and clinical course following antivenom administration were analysed.
Emergency department doctors treated 758 snakebites; 156 patients were admitted of which 51 (33%) received antivenom. Indications for antivenom included: neurotoxicity (24%), haemotoxicity (18%) and significant cytotoxicity (58%). Antivenom-associated adverse events occurred in 61% of patients; with 47% developing anaphylaxis requiring adrenaline infusion. There was a higher incidence of anaphylaxis in children (57%) than in adults (40%), p = 0.55. There was no association between antivenom dose and anaphylaxis. No benefit was noted with adrenaline premedication (p = 0.64), nor with the addition of antihistamine or steroid pre-medicants to adrenaline (p = 0.61). Multivariable logistic regression identified age as a predictor for anaphylaxis, but not dose or duration of antivenom and not any particular form of premedication. Intubation was required in 29% of patients developing anaphylaxis. There were no deaths and all patients made full recovery.
Almost half of the patients at Ngwelezana hospital in Kwazulu-Natal receiving the SAVP polyvalent antivenom developed anaphylaxis requiring adrenaline infusion, with children at higher risk. The administration of this antivenom must only be given for valid indications, in a high-care environment by medical personnel ready to manage anaphylactic shock. The addition of antihistamine and corticosteroids to adrenaline for premedication has no added benefit.
夸祖鲁-纳塔尔省医院经常接诊蛇伤患者，只有少数患者需要使用抗蛇毒血清。本研究回顾了在我们医院使用南非疫苗生产商（SAVP）多价抗蛇毒血清后，与抗蛇毒血清相关的不良事件。
对 2016 年 1 月至 2020 年 4 月期间接受抗蛇毒血清治疗的患者进行回顾性分析。分析患者的人口统计学、临床详细资料和抗蛇毒血清给药后的临床病程。
急诊科医生共治疗了 758 例蛇伤患者；其中 156 例患者住院，51 例（33%）患者接受了抗蛇毒血清治疗。使用抗蛇毒血清的指征包括：神经毒性（24%）、血液毒性（18%）和明显细胞毒性（58%）。61%的患者发生了与抗蛇毒血清相关的不良反应，其中 47%发生了需要肾上腺素输注的过敏反应。儿童（57%）发生过敏反应的比例高于成人（40%），p=0.55。抗蛇毒血清剂量与过敏反应之间无相关性。肾上腺素预先用药无获益（p=0.64），也无获益于肾上腺素联合抗组胺药或皮质类固醇预先用药（p=0.61）。多变量逻辑回归分析发现年龄是过敏反应的预测因素，但与抗蛇毒血清剂量和持续时间以及任何特定形式的预先用药无关。发生过敏反应的患者中有 29%需要插管。无死亡病例，所有患者均完全康复。
夸祖鲁-纳塔尔省恩格韦莱扎纳医院接受 SAVP 多价抗蛇毒血清治疗的患者中，近一半出现过敏反应，需要输注肾上腺素，儿童风险更高。只有在有适应证的情况下，并且在医疗人员准备好应对过敏反应性休克的高护理环境中，才能使用这种抗蛇毒血清。肾上腺素预先用药联合抗组胺药和皮质类固醇并无额外获益。
