Lalloo D G, Trevett A J, Owens D, Minei J, Naraqi S, Saweri A, Hutton R A, Theakston R D, Warrell D A
Department of Clinical Sciences, Faculty of Medicine, University of Papua New Guinea.
Blood Coagul Fibrinolysis. 1995 Feb;6(1):65-72. doi: 10.1097/00001721-199502000-00011.
The mechanisms of haemostatic failure were studied in 87 patients bitten by the Papuan taipan (Oxyuranus scutellatus canni). Eighty (92%) had evidence of a coagulopathy on laboratory testing; 36 (41.4%) developed spontaneous systemic bleeding, although this was rarely of clinical significance. Coagulation assays in 48 completely defibrinated patients showed marked reductions in factors V and VIII and reductions in factors II, IX, XI, XII and XIIIA. There was a reduction in plasminogen and alpha 2-antiplasmin levels and both total and cross-linked fibrin(ogen) degradation products (FDP) levels were elevated. The mean platelet count was initially decreased and fell further during admission. Similar but less severe changes were seen in patients who were mildly defibrinated. Following treatment with antivenom, fibrinogen levels rose rapidly and coagulability was restored within 6-12 h in 93% of patients. These abnormalities may be primarily attributable to the prothrombin activator present in taipan venom, but it is likely that other uncharacterized venom components contributed.
对87例被巴布亚太攀蛇（Oxyuranus scutellatus canni）咬伤的患者的止血功能衰竭机制进行了研究。80例（92%）患者实验室检查有凝血功能障碍证据；36例（41.4%）出现自发性全身出血，不过这在临床上很少具有显著意义。对48例完全去纤维蛋白的患者进行的凝血检测显示，因子V和VIII显著降低，因子II、IX、XI、XII和XIIIA也降低。纤溶酶原和α2-抗纤溶酶水平降低，总纤维蛋白（原）降解产物（FDP）和交联FDP水平均升高。平均血小板计数最初降低，入院期间进一步下降。在轻度去纤维蛋白的患者中也观察到类似但不太严重的变化。用抗蛇毒血清治疗后，纤维蛋白原水平迅速上升，93%的患者在6 - 12小时内恢复凝血能力。这些异常可能主要归因于太攀蛇毒中存在的凝血酶原激活物，但其他未明确的毒液成分可能也有作用。
