Lalloo D G, Trevett A J, Black J, Mapao J, Saweri A, Naraqi S, Owens D, Kamiguti A S, Hutton R A, Theakston R D, Warrell D A
Department of Clinical Sciences, University of Papua New Guinea, Port Moresby.
QJM. 1996 Jan;89(1):25-35. doi: 10.1093/oxfordjournals.qjmed.a030134.
Thirty-two patients with enzyme-immunoassay-proven death adder (Acanthophis sp.) bites were studied in Port Moresby, Papua New Guinea. Eighteen were envenomed; local signs were rare and none had incoagulable blood, but all except one had signs of neurotoxicity. Five (27.7%) envenomed patients required intubation and ventilation. One patient developed renal failure, previously undescribed following death adder bites. Laboratory investigations showed mild prolongation of prothrombin and partial thromboplastin times in some patients. In vitro studies showed that the venom contains anticoagulant activity, but does not cause fibrinogenolysis. In contrast to taipan envenoming, neurotoxicity did not progress after antivenom administration, and there was reversal of neurotoxicity, evident within 6 h, in three severely envenomed patients treated less than 12 h after the bite. One patient treated with antivenom and anticholinesterases had the most dramatic response to treatment; the optimum management of bites by this species may include prompt treatment with both antivenom and anticholinesterases in addition to effective first aid.
在巴布亚新几内亚的莫尔斯比港，对32名经酶免疫测定证实被死亡蝰蛇（棘蛇属）咬伤的患者进行了研究。其中18人发生了中毒；局部症状罕见，无人出现血液无法凝固的情况，但除一人外，所有人都有神经毒性症状。5名（27.7%）中毒患者需要插管和通气。一名患者出现了肾衰竭，这在死亡蝰蛇咬伤后此前未曾有过描述。实验室检查显示，部分患者的凝血酶原时间和部分凝血活酶时间略有延长。体外研究表明，该毒液具有抗凝活性，但不会引起纤维蛋白原溶解。与太攀蛇中毒不同，抗蛇毒血清给药后神经毒性并未进展，3名在咬伤后不到12小时接受治疗的严重中毒患者在6小时内神经毒性出现了逆转。一名接受抗蛇毒血清和抗胆碱酯酶治疗的患者对治疗反应最为显著；该物种咬伤的最佳处理方法可能包括除有效的急救外，同时迅速给予抗蛇毒血清和抗胆碱酯酶治疗。
