台灣地區毒蛇咬傷病人之治療－100個病例分析

Treatment of Snakebite in Taiwan-Analysis of 100 Cases

梁偉中(Wei-Jone Liang) ； 湯有銘(Yeou-Ming Tung) ； 王先震(Hsian-Jenn Wang)

《Journal of Medical Sciences》 13卷1期 (1992/08) Pp. 51-56

摘要

本文論述三軍總醫院自1984至1991年，七年之間治療毒蛇咬傷住院100病例之經驗與結果。其中有26人被赤尾青竹絲（Trimeresurus. s. steingeri）咬傷，23人被龜殼花（Trimeresurus mucrosquamatus）咬傷，3人被雨傘節（Bungarus multicinctus）咬傷，3人被眼鏡蛇（Naja naja atra）咬傷，其餘45人雖未能辨識出攻擊他們的蛇種，但仍因種種臨床表現高度懷疑為毒蛇咬傷而住院。局部傷口疼痛腫脹是最常見的症狀，有兩位病人表現出典型的神經中毒症狀。所有病人都接受了週全的支持療法及至少一劑的抗蛇毒血清治療，七位較嚴重病人則接受了多劑抗蛇毒血清治療。有16位病人在被咬傷後第二至第九天之間接受了廣範切除或清創術，其後有3位病人另接受了植皮術，3位病人接受皮瓣手術以遮蓋其傷口。有3位病人因迫近的compartment症候群發生而接受了筋膜切開術。病人一般的治療結果都很好，沒有死亡或嚴重後遺症發生。當接受抗蛇毒血清治療後，沒有明顯的立即或延遲過敏反應發生。七個嚴重病人接受多劑抗毒血清治療後有非常好的治療效果，此等病人沒有一位必須接受外科手術治療。由以上回顧經驗，我們建議對治療毒蛇咬傷病人必須立即給予週全的支持療法及足夠劑量的抗蛇毒血清治療。我們對於本地所製造的抗蛇毒血清的效果持肯定態度，我們也很驚訝的觀察到本地病人具極低的過敏反應發生率。對於延遲治療病人群中，除了週全的支持療法外，在適當的時機，清創或筋膜切開術則必須高度考慮的。

關鍵字

蛇咬傷 ； 抗蛇毒血清

並列摘要

In the 7-year period, from 1984 to 1991, 100 hospitalized snakebite cases were reviewed. Twenty-six were bitten by Trimeresurus Steingeri, 23 by Trimeresurus mucrosquamatus, 3 by Bungarus multicinctus, 3 by Naja naja atra and the remaining 45 did not identify the snakes, but were admitted because they were highly suspected as venomous snakebite victims by clinical features. Painful swelling was the consistent finding in local wounds. Two cases presented typical systemic neurotoxic symptoms. Full supportive treatment and at least one dose intravenous antivenin were given to every patient. Seven high-grade evenomated patients received multiple doses of antivenin therapy. Sixteen patients received debridement or wide excision procedures between the 2nd to 9th day after the bite. Three of these 16 patients received skin grafts, another 3 received flap surgery for wound coverage. There were 3 patients receiving fasciotomy because of impending compartment syndrome. General results were good. No mortality or major sequela were noted in our series. None showed significant immediate or delayed allergic reactions to the antivenin therapy. Seven high-grade cases received multiple doses of antivenin therapy in their early stage with excellent results. All 7 patients recovered uneventfully without surgical management. From our experience, we recommend full supportive treatment, adequate dose of antivenin in every early arrival patients. The effectiveness of the antivenin produced in our locality assured was and the low incidence of allergic reactions to the antivenin was impressive. For delayed treatment patients, debridement/excision with appropriate wound coverage operations should be highly considered.

並列關鍵字

Snakebite ； Antivenin