Chen Feng-Chen, Ismail Ahmad Khaldun, Mao Yan-Chiao, Hsu Chih-Hsiung, Chiang Liao-Chun, Shih Chang-Chih, Tzeng Yuan-Sheng, Lin Chin-Sheng, Liu Shing-Hwa, Ho Cheng-Hsuan
Department of Emergency Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung 80284, Taiwan.
Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11402, Taiwan.
Trop Med Infect Dis. 2023 Apr 24;8(5):246. doi: 10.3390/tropicalmed8050246.
Patients bitten by typically experience significant pain, substantial swelling, and potentially blister formation. The appropriate dosage and efficacy of FHAV for alleviating local tissue injury remain uncertain. Between 2017 and 2022, 29 snakebite patients were identified as being bitten by . These patients underwent point-of-care ultrasound (POCUS) assessments at hourly intervals to measure the extent of edema and evaluate the rate of proximal progression (RPP, cm/hour). Based on Blaylock's classification, seven patients (24%) were classified as Group I (minimal), while 22 (76%) were classified as Group II (mild to severe). In comparison to Group I patients, Group II patients received more FHAV (median of 9.5 vials vs. two vials, -value < 0.0001) and experienced longer median complete remission times (10 days vs. 2 days, -value < 0.001). We divided the Group II patients into two subgroups based on their clinical management. Clinicians opted not to administer antivenom treatment to patients in Group IIA if their RPP decelerated. In contrast, for patients in Group IIB, clinicians increased the volume of antivenom in the hope of reducing the severity of swelling or blister formation. Patients in Group IIB received a significantly higher median volume of antivenom (12 vials vs. six vials; -value < 0.001) than those in Group IIA. However, there was no significant difference in outcomes (disposition, wound necrosis, and complete remission times) between subgroups IIA and IIB. Our study found that FHAV does not appear to prevent local tissue injuries, such as swelling progression and blister formation, immediately after administration. When administering FHAV to patients bitten by , the deceleration of RPP may serve as an objective parameter to help clinicians decide whether to withhold FHAV administration.
被[蛇名未给出]咬伤的患者通常会经历剧烈疼痛、明显肿胀，并可能形成水泡。FHAV缓解局部组织损伤的合适剂量和疗效仍不确定。在2017年至2022年期间，29名蛇咬伤患者被确定为被[蛇名未给出]咬伤。这些患者每隔一小时接受一次床旁超声（POCUS）评估，以测量水肿程度并评估近端进展速度（RPP，厘米/小时）。根据布莱洛克分类，7名患者（24%）被归类为I组（轻度），而22名（76%）被归类为II组（轻度至重度）。与I组患者相比，II组患者接受了更多的FHAV（中位数为9.5瓶对2瓶，P值<0.0001），并且经历了更长的中位数完全缓解时间（10天对2天，P值<0.001）。我们根据临床管理将II组患者分为两个亚组。如果IIA组患者的RPP减速，临床医生选择不给他们使用抗蛇毒血清治疗。相比之下，对于IIB组患者，临床医生增加了抗蛇毒血清的用量，希望减轻肿胀或水泡形成的严重程度。IIB组患者接受的抗蛇毒血清中位数剂量（12瓶对6瓶；P值<0.001）明显高于IIA组患者。然而，IIA组和IIB组亚组之间在结局（处置、伤口坏死和完全缓解时间）方面没有显著差异。我们的研究发现，FHAV给药后似乎并不能立即预防局部组织损伤，如肿胀进展和水泡形成。在给被[蛇名未给出]咬伤的患者使用FHAV时，RPP的减速可能作为一个客观参数，帮助临床医生决定是否停止使用FHAV。
