Risk Factors of Surgical Intervention in the Management of Venomous Snakebite in Northern Taiwan

北台灣地區毒蛇咬傷後需手術處理之危險因子研究

石育仲(Yu-Chung Shih) ； 馬旭(Hsu Ma) ； 葉發來(Fa-Lai Yeh) ； 林進德(Jin-The Lin) ； 黃志宏(Chih-Hung Hwang) ； 沈秉輝(Mau-Shan Wang) ； 王茂山(Cherng-Kang Perng) ； 彭成康(Bing-Hwei Shen) ； 陳建華(Chien-Hua Chen)

《中華民國整形外科醫學會雜誌》 15卷4期 (2006/12) Pp. 367-376

https://doi.org/10.7096/JPSA.200612.0367

摘要

台灣地處亞熱帶，毒蛇咬傷相當常見，可能會造成局部或全身的中毒現象，紅腫、瘀青、皮膚壞死及壞死性筋膜炎都是可能出現的局部併發症，也往往需要手術治療，不過仍然避免不了局部的功能障礙。因此，希望能找出相關危險因子，以減少需要手術的個案。
我們蒐集並分析過去五年台北榮總毒蛇咬傷的118個個案並統計分析可能造成需要手術處理的危險因子，在118位病人中，共有16位需要接受手術治療，可能的危險因子包括了：眼鏡蛇咬傷及延遲給予抗毒血清。
眼鏡蛇咬傷容易造成局部皮膚壞死和感染，因此需要接受手術治療的機會也比較高，早期給予抗毒血清及廣效抗生素可能可以減少局部的併發症而進一步減少手術的需要。

並列摘要

Venomous snakebites are not uncommon in Taiwan, and the snake venom causes both systemic and local effects. Petechiae, edema, swelling, ecchymosis, necrosis of the skin and subcutaneous tissue, and necrotizing fasciitis could be seen locally, and surgical intervention may be needed to deal with these problems. However, functional impairment and limb loss were still sometimes inevitable. We retrospectively reviewed medical records of 118 patients bitten by venomous snakes from Jan. 1999 to Dec. 2004, and risk factors of surgical intervention were studied. The relationship of the need of surgical intervention and snake species, clinical grading, symptoms, and other associating factors were analyzed. Surgery was needed in 16 of 118 patients(13.5%)bitten by venomous snakes, 7 by Taiwan cobra, 5 by Taiwan habu, 1 by green habu, 1 by hundred pacer, and 2 by unknown snake. Risk factors of surgical intervention were Taiwan cobra snakebite(7/14)and delayed given of antivenom. Taiwan cobra snakebite was found with higher risk of local necrosis and infection. Therefore, more surgical interventions were needed in this group of patients, and early antivenom given and broad spectrum antibiotics coverage were recommended

並列關鍵字

venomous snakebite ； surgery