泰国刺伤者中箱型水母螫伤的皮肤学影响：被低估的严重程度。

The Dermatological Effects of Box Jellyfish Envenomation in Stinging Victims in Thailand: Underestimated Severity.

机构信息

Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

出版信息

Wilderness Environ Med. 2023 Dec;34(4):462-472. doi: 10.1016/j.wem.2023.06.007. Epub 2023 Aug 6.

DOI:10.1016/j.wem.2023.06.007

PMID:37550104

Abstract

INTRODUCTION

The dermatological effects of box jellyfish envenomation among stinging victims in Thailand are not well reported, particularly concerning chronic effects. For first aid, different recommendations indicate the necessity for the removal of tentacles in life-threatening situations. This study aimed to describe the dermatological effects of box jellyfish envenomation and propose recommendations regarding first aid for victims in urgent care or life-threatening situations.

METHODS

Surveillance systems and Toxic Jellyfish Networks were established to improve detection and investigation. The networks investigated all severe victims of jellyfish envenomation. A retrospective study was conducted, and victims of stinging by box jellyfish investigated from 1999 to 2021 were included.

RESULTS

One hundred and twenty-four victims were recorded. The majority of victims were males (55%), tourists (69%), and Thai nationals (49%). Direct contact had more severe consequences than indirect contact. Dermatological effects included edema, erythematous caterpillar track-like rash, blistering, bullae, papular eruption, necrosis, digital gangrene, recurrent dermatitis, dermal hypersensitivity, numbness, lichenification, hyperpigmentation, keloids, and scarring. Suffering and healing continued from several weeks to many years. Victims with multiple-tentacle box jellyfish stings had papular eruptions and greater severity of skin issues. All fatally envenomed victims collapsed within a few minutes and received incorrect/no first aid. The proposed first aid for life-threatening box jellyfish stings is continuous irrigation of the wound with vinegar for at least 30 s and initiation of cardiopulmonary resuscitation if there is no respiration or heartbeat. Tentacles often detach spontaneously, and removal is not always necessary, thus saving time.

CONCLUSIONS

The findings provide input for improving diagnosis and treatment guidelines.

摘要

简介

在泰国，被箱型水母螫伤的刺痛受害者的皮肤影响尚未得到充分报告，尤其是慢性影响。对于急救，不同的建议表明在危及生命的情况下有必要去除触须。本研究旨在描述箱型水母螫伤的皮肤影响，并针对紧急护理或危及生命的情况下的受害者提出急救建议。

方法

建立了监测系统和有毒水母网络，以提高检测和调查能力。该网络调查了所有严重的水母螫伤受害者。进行了一项回顾性研究，纳入了 1999 年至 2021 年期间被箱型水母螫伤的受害者。

结果

记录了 124 名受害者。大多数受害者为男性（55%）、游客（69%）和泰国人（49%）。直接接触比间接接触后果更严重。皮肤影响包括水肿、红斑毛毛虫样疹、水疱、大疱、丘疹性皮疹、坏死、手指坏疽、复发性皮炎、皮肤过敏、麻木、苔藓样变、色素沉着、瘢痕疙瘩和瘢痕形成。痛苦和愈合持续数周至数年。有多根触须的箱型水母螫伤的受害者会出现丘疹性皮疹和更严重的皮肤问题。所有致命性螫伤的受害者在几分钟内倒下，且接受了错误/未接受急救。对于危及生命的箱型水母螫伤的急救方法是用醋持续冲洗伤口至少 30 秒，如果没有呼吸或心跳，立即开始心肺复苏术。触须通常会自动脱落，并不总是需要去除，从而节省时间。