Wright S W, Wrenn K D, Murray L, Seger D
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Ann Emerg Med. 1997 Jul;30(1):28-32. doi: 10.1016/s0196-0644(97)70106-9.
To examine the clinical presentation and outcome of patients treated in the ED or toxicology clinic for suspected brown recluse spider bites.
We assembled a retrospective case of patients at a southeastern US university hospital. Our study group comprised 111 patients with suspected brown recluse spider bites treated during a 30-month period. Our main outcome measures were the need for skin grafting and the development of other complications.
The mean age of our subjects was 34 +/- 17 years. Thirteen patients (12%) brought the spider to the hospital, 22 (20%) saw a spider at the time of the bite, and an exclusively clinical diagnosis was made in the remaining 76 (68%). Most wounds (59%) involved the leg. At the time of presentation, 81% had central discoloration and 37% necrosis. Sixteen patients (14%) were systemically ill, and 6 (5%) were admitted to the hospital. Most (86%) were treated with antibiotics. Dapsone was infrequently used (9%) and had usually been prescribed before the patient's presentation to our ED. Only three patients (3%; 95% confidence interval, 1% to 8%) required grafting. Mild hemolytic anemia developed in one patient, and another had mild hemolysis and a mild coagulopathy; neither patient was taking dapsone. No deaths or serious complications occurred in our study group.
In our series, long-term outcome after brown recluse spider bite was good. Serious complications were rare, as was the need for skin grafting. Because the vast majority of bites heal with supportive care alone, aggressive medical therapy does not appear warranted.
探讨在急诊科或毒理学诊所接受治疗的疑似棕色遁蛛咬伤患者的临床表现及预后。
我们收集了美国东南部一所大学医院患者的回顾性病例。我们的研究组包括111例在30个月期间接受治疗的疑似棕色遁蛛咬伤患者。我们的主要结局指标是皮肤移植的需求及其他并发症的发生情况。
我们研究对象的平均年龄为34±17岁。13例患者（12%）将蜘蛛带到医院，22例（20%）在咬伤时看到了蜘蛛，其余76例（68%）仅通过临床诊断。大多数伤口（59%）累及腿部。就诊时，81%有中心色素沉着，37%有坏死。16例患者（14%）有全身症状，6例（5%）住院。大多数患者（86%）接受了抗生素治疗。氨苯砜很少使用（9%），且通常是在患者到我们急诊科就诊前就已开具处方。仅3例患者（3%；95%置信区间，1%至8%）需要进行移植。1例患者出现轻度溶血性贫血，另1例有轻度溶血和轻度凝血障碍；这两名患者均未服用氨苯砜。我们的研究组未发生死亡或严重并发症。
在我们的系列研究中，棕色遁蛛咬伤后的长期预后良好。严重并发症罕见，皮肤移植的需求也很少。由于绝大多数咬伤仅通过支持治疗即可愈合，因此似乎没有必要进行积极的药物治疗。
