Prognostic Factors of Local Necrosis Due to Poisonous Snakebite-A Clinical Review in Mackay Memorial Hospital

毒蛇咬傷造成局部壞死的危險因子－在馬偕醫院的臨床研究

游家孟(Chia-Meng Yu) ； 黃文成(Wen-Chen Huang) ； 董光義(Kwang-Yi Tung) ； 蕭弘道(Hung-Tao Hsiao) ； 歐聖運(Shuan-Yuan Ou)

《中華民國整形外科醫學會雜誌》 14卷1期 (2005/03) Pp. 31-40

https://doi.org/10.7096/JPSA.200503.0031

摘要

探討北台灣因毒蛇咬傷造成傷口壞死的危險因子，以决定適當的治療方法。從1989年到2000年間，共有117個患者因毒蛇咬傷而住進北台灣某醫學中心，我們以迴溯方式研究所有病歷，將傷口壞死與正常愈合的病例區分開後，把臨床症狀區分爲五級，以Chi-Square法統計傷口壞死、臨床症狀與相關危險因子的關係。大部份病患(74%)是被青竹絲或龜殼花咬傷且症狀輕微，好犯於八月與十月。統計結果顯示與傷口壞死相關的因子為：毒蛇種類、局部切開、局部住射抗毒血清、抗生素給予天數、臨床症狀嚴重度及住院天數。早期給予全身性的抗毒血清是治療因毒蛇咬傷造成傷口壞死的有效方法，局部切開或局部住射抗毒血清則不予以推薦，延長使用抗生素的時間並不是傷口壞死的必要治療方法。

並列摘要

Purpose: To evaluate the prognostic factors of wound necrosis due to snakebite in northern Taiwan and determine the proper treatment for snakebites.
Methods: The medical records of 117 venomous snakebite patients admitted to a medical center in northern Taiwan from 1989 to 2000 were retrospectively reviewed. The patients were separated into wound necrosis patients and normal wound healing patients. Clinical envenomation was graded on a 5-point scale. The relationship of wound necrosis, clinical grades, and associating factors was analyzed using the Chi-square method.
Results: Most (74%) patients were attacked by the green habu (41 patients) and the Taiwan habu (44 patients), and most (84%) had minimal or no envenomation. The peak months of accidents were August and October. The prognostic factors related to wound necrosis were: species of snakes, local incision, local injection of antivenom, days of antibiotics given, grade of envenomation, and duration of hospital stay.
Conclusion: Systemic infusion of early adequate antivenom is the effective method in preventing wound necrosis due to venomous snakebites. Local incision or local injection of antivenom is not recommended in the treatment program. Prolonged use of antibiotics is not necessary in patients with wound necrosis.

並列關鍵字

snakebite ； necrosis ； Taiwan