Treatment of Venomous Snakebites in Eastern Taiwan

東台灣地區毒蛇咬傷之治療經驗

吳孟熹(Meng-Si Wu) ； 李俊達(Jiunn-Tat Lee) ； 孫宗伯(Tzong-Bor Sun) ； 鄭立福(Li-Fu Cheng) ； 王健興(Chien-Hsing Wang) ； 許宏達(Hon-Da Hsu) ； 黃介琦(Chieh-Chi Huang) ； 簡守信(Sou-Hsin Chien)

《中華民國整形外科醫學會雜誌》 18卷3期 (2009/09) Pp. 257-265

https://doi.org/10.7096/JPSA.200909.0257

摘要

背景：
雖然近幾年毒蛇咬傷的發生率因環境變遷而下降，它仍然可能帶來嚴重的併發症甚至死亡。
目的及目標：
本研究目的在探討分析東台灣毒蛇咬傷之治療及結果，以期能改善處置並減少併發症。
材料及方法：
回溯性收集並分析花蓮慈濟醫院從民國89年1月到93年9月，因毒蛇咬傷住院接受治療病患之基本資料、蛇種、臨床表現、治療過程及結果。
結果：
本研究共收集93位病患。病患年齡以40至49歲最多，約佔27%。毒蛇種類以龜殼花最多，佔29%，其它依序為青竹絲(16.1%)及眼鏡蛇(7.5%)，蛇種不明亦佔約34%。受傷部位則以上肢最為常見(60%)。共24例(25.8%)病患接受手術治療，其中17例(18.3%)為筋膜切開術。未接受手術者平均住院天數為4.2天，接受手術者則為18.8天。死亡病例共一例。
結論：
手術治療在特定病人上仍有其必要性，而且我們建議應依不同蛇種擬訂個別治療流程。

並列摘要

Background:
The incidence of snakebites decreased gradually in recent years due to change of the socioeconomic environment in Taiwan. However, venomous snakebites still can cause severe morbidity and even death occasionally.
Aim and Objectives:
This report described treatment and result of poisonous snakebites in Eastern Taiwan. We hope to improve management and decrease complications.
Materials and Methods:
The medical records of the patients admitted to the Buddhist Tzu Chi General Hospital due to venomous snakebites from Jan 2000 to Sep 2004 were retrospectively reviewed. The patient's demographic data, species of causative snake, manifestations of envenomation, treatment and clinical course were collected and analyzed.
Results:
There were 93 cases of snakebites collected. Most of the snakebites (27%) occurred in the fourth decade of age. The species of snakebites included: Taiwan habu bites (29%), Taiwan bamboo viper bites (16%), cobra bites (7.5%) and unknown bites (34%). The most common locations of the bite were in the upper extremity (60%). 24 patients (25.8%) required surgical intervention, including fasciotomy which was performed in 17 patients (18.3%). The average lengths of hospital stay in non-operated group and operated group were 4.2 days and 18.8 days respectively. Acute renal failure developed in three patients, and one of them required temporary hemodialysis. There was only one death in this series.
Conclusion:
Surgical intervention is indicated in a particular group of patients and different treatment algorithms should be developed according to snake species to decrease the morbidity of venomous snakebites.

並列關鍵字

venomous snakebite ； antivenom ； surgery