The Australian Snakebite Project, 2005-2015 (ASP-20)
The Australian Snakebite Project, 2005-2015 (ASP-20)
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DOI：
10.5694/mja17.00094
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发表时间：
2017-08-07
影响因子：
11.4
通讯作者：
Isbister, Geoffrey K.
中科院分区：
文献类型：
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作者：
Johnston, Christopher I.;Ryan, Nicole M.;Isbister, Geoffrey K.
目的：描述澳大利亚蛇咬伤的流行病学、治疗和不良事件。设计：前瞻性、多中心研究，收集澳大利亚蛇咬伤项目招募的蛇咬伤患者的数据（2005-2015年）和来自国家冠状信息系统的数据。2005年7月至2015年6月期间因疑似或确诊蛇咬伤前往澳大利亚医院就诊并同意参与研究的患者。主要结局指标：人口统计学数据、咬伤情况、蛇毒注射的临床效果、实验室调查和蛇毒检测试剂盒（SVDK）检测结果、抗蛇毒血清治疗和不良反应、出院时间、死亡人数。1548例疑似蛇咬伤患者入组，包括835例蛇毒患者（中位数，每年87），其中718种蛇的类型是明确确定的，最常见的是棕色蛇（41%），虎蛇（17%）和红腹黑蛇（16%）。临床效应包括毒液诱导的消耗性凝血病（73%）、肌毒性（17%）和急性肾损伤（12%）;严重并发症包括心脏骤停（25例; 2.9%）和大出血（13例; 1.6%）。有23人死亡（中位数，每年2人），归因于棕色（17），老虎（4）和未知（2）蛇; 10人随后院外心脏骤停，6人随后颅内出血。在597例确认为蛇型的中毒患者的SVDK检测结果中，29例（4.9%）不正确;在364例非中毒患者的SVDK检测结果中，133例（36%）为假阳性。755名患者接受抗蛇毒血清治疗，包括49名非蛇毒患者; 178名（24%）患者（包括10名非蛇毒患者）发生全身超敏反应，其中45名（6%）为重度（低血压、低氧血症）。抗蛇毒血清的中位总剂量从4瓶下降到1瓶，但第一次抗蛇毒血清的中位时间不变（4.3小时; IQR，2.7-6.3小时）。SVDK用于确定蛇的类型是不可靠的。抗蛇毒血清的剂量已经下降，但没有伤害到病人。需要改进的早期诊断策略，以减少抗蛇毒血清给药前经常出现的长时间延迟。
Objective: To describe the epidemiology, treatment and adverse events after snakebite in Australia.Design: Prospective, multicentre study of data on patients with snakebites recruited to the Australian Snakebite Project (2005-2015) and data from the National Coronial Information System.Setting, participants: Patients presenting to Australian hospitals with suspected or confirmed snakebites from July 2005 to June 2015 and consenting to participation.Main outcome measures: Demographic data, circumstances of bites, clinical effects of envenoming, results of laboratory investigations and snake venom detection kit (SVDK) testing, antivenom treatment and adverse reactions, time to discharge, deaths.Results: 1548 patients with suspected snakebites were enrolled, including 835 envenomed patients (median, 87 per year), for 718 of which the snake type was definitively established, most frequently brown snakes (41%), tiger snakes (17%) and red-bellied black snakes (16%). Clinical effects included venom-induced consumption coagulopathy (73%), myotoxicity (17%), and acute kidney injury (12%); severe complications included cardiac arrest (25 cases; 2.9%) and major haemorrhage (13 cases; 1.6%). There were 23 deaths (median, two per year), attributed to brown (17), tiger (four) and unknown (two) snakes; ten followed out-of-hospital cardiac arrests and six followed intracranial haemorrhages. Of 597 SVDK test results for envenomed patients with confirmed snake type, 29 (4.9%) were incorrect; 133 of 364 SVDK test results for non-envenomed patients (36%) were false positives. 755 patients received antivenom, including 49 non-envenomed patients; 178 (24%), including ten non-envenomed patients, had systemic hypersensitivity reactions, of which 45 (6%) were severe (hypotension, hypoxaemia). Median total antivenom dose declined from four vials to one, but median time to first antivenom was unchanged (4.3 hours; IQR, 2.7-6.3 hours).Conclusions: Snake envenoming is uncommon in Australia, but is often severe. SVDKs were unreliable for determining snake type. Themedian antivenom dose has declined without harming patients. Improved early diagnostic strategies are needed to reduce the frequently long delays before antivenom administration.