Venomous Snakebites
Venomous Snakebites
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DOI：
10.3390/medicina47080061
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发表时间：
2011-01-01
影响因子：
2.6
通讯作者：
Adukauskaite, Agne
中科院分区：
文献类型：
--
作者：
Adukauskiene, Dalia;Varanauskiene, Egle;Adukauskaite, Agne
每年有500多万人被毒蛇咬伤，其中超过10万人死亡。在欧洲，每三年就有一人死于中毒。立陶宛只有一种毒蛇--普通毒蛇(Vipera Berus)--属于毒蛇科；然而，动物园和私人收藏中有一些外来毒蛇，如属于眼镜蛇科的毒蛇(眼镜蛇、曼巴、珊瑚蛇等)。以及响尾蛇科(响尾蛇科)的鳄亚科。根据蛇毒种类的不同，蛇毒可分为血液毒性、神经毒性、坏死性、心脏毒性和肾脏毒性(即大鸦科和蛇科蛇毒的血液毒性和坏死性较强，而眼镜蛇科的蛇毒主要为神经毒性)。根据这些症状的出现来判断中毒的程度：1)无中毒(“干”咬)；2)轻度中毒(局部浮肿和疼痛)；3)中度中毒(疼痛、从咬合区扩散出来的浮肿和全身体征)；4)重度中毒(休克、严重凝血障碍和大量水肿症)。这个话题是相关的，因为人们在提供急救时往往会犯下重大错误(例如，嘴巴抽吸、伤口切开、冰块或热敷)。因此，本文就如何根据世界卫生组织《蛇咬伤管理指南》(2010)做好急救工作提出一些基本的建议。首先，应该让受害者放心。必须移除环或其他东西，以防止肿胀肢体的收缩。必须维持呼吸道/呼吸。被咬伤的肢体应该固定，并保持在心脏水平以下，以防止毒液吸收和全身传播。压力绷带的使用是有争议的，因为人们通常不适当地使用它。不应进行切开、吸口或切除；既不应使用止血带，也不应使用冰块或热源。医生必须监测呼吸频率、血压、心率、肾功能、液体平衡和凝血状态。唯一特异的治疗方法是用抗蛇毒抗原抗体的抗蛇毒血清。在美国用于对抗毒蛇的抗蛇毒血清有多价抗蛇毒血清(ACP)和一种纯度更高、因此引起不良反应较少的Crotalidae多价免疫抗体(CroFab)。在欧洲，可以使用针对毒蛇科蛇(包括普通毒蛇)的多价抗血清。由于其蛋白质性质，抗蛇毒血清常常会引起严重的超敏反应。普通毒蛇(立陶宛和英国等国唯一的毒蛇)的咬伤相对较少导致死亡；因此，考虑到抗蛇毒血清本身引起危险反应的风险，建议仅限于危及生命的情况下使用。
More than 5 million people are bitten by venomous snakes annually and more than 100 000 of them die. In Europe, one person dies due to envenomation every 3 years. There is only one venomous snake species in Lithuania the common adder (Vipera berus) - which belongs to the Viperidae family; however, there are some exotic poisonous snakes in the zoos and private collections, such as those belonging to the Elapidae family (cobras, mambas, coral snakes, etc.) and the Crotalidae subfamily of the Viperidae family (pit vipers, such as rattlesnakes). Snake venom can be classified into hemotoxic, neurotoxic, necrotoxic, cardiotoxic, and nephrotoxic according to the different predominant effects depending on the family (i.e., venom of Crotalidae and Viperidae snakes is more hemotoxic and necrotoxic, whereas venom of Elapidae family is mainly neurotoxic). The intoxication degree is estimated according to the appearance of these symptoms: 1) no intoxication ("dry" bite); 2) mild intoxication (local edema and pain); 3) moderate intoxication (pain, edema spreading out of the bite zone, and systemic signs); 4) severe intoxication (shock, severe coagulopathy and massive edemas). This topic is relevant because people tend to make major mistakes providing first aid (e.g., mouth suction, wound incision, and application of ice or heat). Therefore, this article presents the essential tips on how first aid should be performed properly according to the "Guidelines for the Management of Snake-Bites" by the World Health Organization (2010). Firstly, the victim should be reassured. Rings or other things must be removed preventing constriction of the swelling limb. Airway/breathing must be maintained. The bitten limb should be immobilized and kept below heart level to prevent venom absorption and systemic spread. Usage of pressure bandage is controversial since people usually apply it improperly. Incision, mouth suction, or excision should not be performed; neither a tourniquet nor ice or heat should be applied. A doctor must monitor respiratory rate, blood pressure, heart rate, renal function, fluid balance, and coagulation status. The only specific treatment method is antivenin serum with antibodies against antigens of snake venom. Antivenins against pit vipers used in the United States are Antivenin Crotalidae Polyvalent (ACP) and a more purified and hence causing less adverse reactions Crotalidae Polyvalent Immune Fab (CroFab). In Europe, a polyvalent antiserum against Viperidae family snakes (including the common adder) can be used. Antivenins often may cause severe hypersensitivity reactions because of their protein nature. The bite of the common adder (the only poisonous snake in such countries as Lithuania and Great Britain) relatively rarely results in death; thus, considering the risk of dangerous reactions the antivenin causes itself, the usage of it is recommended to be limited only to life-threatening conditions.