台灣眼鏡蛇傷害－台北榮總毒藥物諮詢中心之病例分析－

眼鏡蛇屬於神經性毒蛇。眼鏡蛇蛇毒同時具有神經性毒性、心臟毒性及溶血的特性，其臨床變化為多變性的，依各地的蛇種及蛇毒成分比例的不同而有所不同。台灣眼鏡蛇除了能咬傷人外，亦能噴出毒液到對方眼睛造成傷害。我們就台北榮總毒物諮詢中心自1986到1998年之間收集之43位眼鏡蛇傷害病例進行分析，其中36位病例為眼鏡蛇咬傷，7位被毒液噴到眼睛。研究發現被台灣眼鏡蛇咬傷者，有94.4%產生局部腫脹，38.9%產生皮膚壞死或傷口癒合不良現象，19.4%產生非特異全身症狀，所有的病例都沒有出現典型的神經學症狀或死亡。接受之處置方面，手術切開排毒13.9%、抗神經蛇毒血清治療94.4%、手術清創19.4%、皮膚移值13.9%、截指手術2.8%、高壓氧治療2.8%及尋求中醫療法者16.7%。被毒液噴到眼睛者，全部有輕度眼睛症狀，14.3%有非特異全身症狀，預後皆良好，都未接受抗蛇毒血清。台灣地區的眼睛蛇已知具有相對較大量的細胞毒素（心臟毒素），為造成皮膚腫脹壞死的主因，故台灣地區眼鏡蛇咬傷的臨床表現為顯著的局部症狀，而神經症狀少見或很輕微。

關鍵字

眼鏡蛇；心臟毒素；神經性毒性；壞死

並列摘要

Cobra is classified as a neurotoxic snake. It’s venom possess neurotoxic, cardiotoxic and hemotoxic properties. The clinical features of cobra bite are various, depend on the species and the ratio of the venous component. Taiwan cobra is capable of poisoning both by biting or by spitting its venom. We studied 43 patients from Poison-Control-Center during 1986 ~ 1998, 36 patients envenomed by biting and 7 patients envenomed by spitting to the eye. There were 94.4 % patients with local swelling, 38.9 % patients with necrosis or wound poor healing. and 19.4% with non-specific systemic symptoms after Taiwan Cobra bite.. Both mortality and typical signs of neurotoxicity were absent. The management modalities include incision 13.9%, neurotoxic antivenin 94.4%, debridment 19.4%, skin graft 13.9%, amputation of finger 2.8%, hyperbaric therapy 2.8% and herb therapy 16.7%。 In patients envonmoned by spitting to the eye, all had mild local eye symptoms, 14.3% had non-specific systemic symptoms, all had good prognosis without anti-venin therapy. The Taiwan cobra (Naja naja atra), known to possess a relative large percentage of cardiotoxin, causes the tissue local swelling and necrosis. Bites by the Taiwan cobra produce a distinctive clinical picture characterized by prominent local effect with few neurotoxicity.

並列關鍵字

Taiwan Cobra ； Naja naja atra ； cardiotoxin ； neurotoxicity ； necrosis

國際替代計量

台灣眼鏡蛇傷害－台北榮總毒藥物諮詢中心之病例分析－

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