CLINICAL PRESENTATION AND TREATMENT OF BLACK-WIDOW SPIDER ENVENOMATION - A REVIEW OF 163 CASES
CLINICAL PRESENTATION AND TREATMENT OF BLACK-WIDOW SPIDER ENVENOMATION - A REVIEW OF 163 CASES
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DOI：
10.1016/s0196-0644(05)81021-2
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发表时间：
1992-07-01
影响因子：
6.2
通讯作者：
GERKIN, R
中科院分区：
文献类型：
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作者：
CLARK, RF;WETHERNKESTNER, S;GERKIN, R
研究目的：回顾黑寡妇蜘蛛中毒的临床表现，评价其治疗效果。设计：回顾性图表回顾。地点：城市毒物学转诊中心。研究对象：1982年1月至1990年12月在毒理学中心就诊的所有被诊断为黑寡妇蜘蛛中毒的出院患者。干预：纳入标准为阳性的黑寡妇蜘蛛或可见的毒物部位(“靶标病变”)。根据临床表现，患者按严重程度分为1级、2级或3级。对治疗方案的疗效和副作用进行评估。测量和主要结果：163名患者符合纳入标准。最常见的中毒部位是上肢和下肢。最常见的主诉是全身腹痛、背痛和腿痛。118名患者最初出现在我们机构，45名患者被转院。2级和3级毒液的疼痛缓解最有效的是单独使用黑寡妇蜘蛛特异性抗蛇毒素，或者联合使用静脉注射阿片类药物和肌肉松弛药。58例患者接受了抗蛇毒血清治疗，症状完全消失，平均时间为31+/-6.7分钟。在我们机构初诊的118名患者中，接受抗蛇毒血清治疗的患者平均总症状持续时间为9+/-22.7小时，而未接受抗蛇毒血清治疗的患者平均总症状持续时间为22+/-24.9小时。没有接受抗蛇毒血清治疗的患者中有52%需要住院治疗，而接受抗蛇毒血清治疗的患者中只有12%需要住院治疗。1例在接受抗蛇毒血清治疗后死于严重的支气管痉挛。在这一系列中，葡萄糖酸钙在缓解症状方面无效，96%的2级和3级毒液最初使用葡萄糖酸钙治疗，需要添加静脉阿片类药物或其他止痛剂以缓解症状。在最初接受静脉注射吗啡的患者中，55%的患者和最初同时接受静脉注射吗啡和苯二氮卓类药物的患者中有70%的患者在没有额外药物的情况下获得了症状缓解。
Study objective: To review cases of black widow spider envenomation to describe the clinical presentation and evaluate the efficacy of treatment.Design: Retrospective chart review.Setting: An urban toxicology referral center.Type of participants: All patients attended by the toxicology service and discharged from our hospital between January 1982 and December 1990 with a diagnosis of black widow spider envenomation.Interventions: Inclusion criteria were either a positive black widow spider identification or a visible envenomation site ("target lesion"). Depending on the clinical presentation, patients were categorized as grade 1, 2, or 3 in severity. The efficacy and side effects of treatment alternatives were evaluated.Measurements and main results: One hundred sixty-three patients met the inclusion criteria. The most common sites of envenomation were the upper and lower extremities. The most common presenting complaint was generalized abdominal, back, and leg pain. One hundred eighteen patients initially presented to our institution, and 45 were transfers. Pain relief of grade 2 and 3 envenomations was achieved most effectively with either black widow spider-specific antivenin alone or a combination of IV opioids and muscle relaxants. Fifty-eight patients received antivenin with complete resolution of symptoms in a mean time of 31 +/- 6.7 minutes. Of the 118 patients initially seen at our institution, the mean total duration of symptoms was 9 +/- 22.7 hours in patients receiving antivenin and 22 +/- 24.9 hours in patients not receiving antivenin. Fifty-two percent of patients not receiving antivenin required hospitalization, whereas only 12% of those receiving antivenin were admitted. One patient died of severe bronchospasm after receiving antivenin. Calcium gluconate was not effective in providing symptomatic relief in this series, with 96% of the grade 2 and 3 envenomations treated initially with calcium gluconate requiring the addition of IV opioids or other analgesics for symptomatic relief. Fifty-five percent of patients initially receiving IV morphine and 70% of those initially receiving both IV morphine and benzodiazepines obtained symptomatic relief without additional medication.