European viper envenomings: Assessment of Viperfav™ and other symptomatic treatments
European viper envenomings: Assessment of Viperfav™ and other symptomatic treatments
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DOI：
10.3109/15563650.2012.660695
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发表时间：
2012-03-01
影响因子：
3.3
通讯作者：
Harry, Patrick
中科院分区：
文献类型：
--
作者：
Boels, David;Hamel, Jean Francois;Harry, Patrick
欧洲毒蛇中毒的治疗基于静脉注射抗蛇毒血清。 Viperfav (TM) 含有纯化的马抗体 F(ab')(2) 片段，4 ml 小瓶可中和 500-1000 小鼠 Vipera aspis、V. ammodytes 和 V. berus 毒液的 LD50，已知安全有效。目前尚未报道 Viperfav (TM)（输注剂量和时间）以及低分子肝素 (LWHM)、皮质类固醇和常规使用抗生素治疗等对症治疗的评估。目标。目的是比较 Viperfav (TM) 的功效和安全性随输注时间的变化，并评估欧洲毒蛇咬伤的其他对症治疗，如抗生素、皮质类固醇和 LWMH。方法。昂热毒药中心编制了一项用 Viperfav (TM) 治疗毒蛇毒液的前瞻性病例回顾研究。选择的终点如下：住院时间、并发症（血肿、感染）和第 15 天持续的功能不适。统计研究基于多变量数据分析 (MVA)。结果。该研究纳入了 1999 年至 2009 年间记录的 268 起成人和儿童中度或重度中毒事件（II 级和 III 级）。被咬后注射 Viperfav (TM) 的时间 < 10 小时（179 名患者与 72 名患者）显着降低了血肿的发生率（OR 2.3；p < 0.006）、功能不适（OR 3.7；p < 10-4）和住院时间（OR 2.1；p < 0.03）。多次剂量的 Viperfav (TM)（22 名患者服用 2 或 3 瓶，对比 246 名患者服用 1 瓶）并没有改善选定的终点。 102 名患者接受了常规抗生素治疗（对比 166 名患者没有接受常规抗生素治疗），终点方面没有发现显着差异。此外，非抗生素组没有记录到局部或全身感染。 36 名患者接受了皮质类固醇治疗（232 名患者没有接受皮质类固醇治疗），但并未显着改善终点或水肿。 32 名患者（相对于 236 名未接受 LMWH）延长了住院时间（OR 3.2；p < 0.009，并增加了第 15 天显着持续的功能不适水平（OR 3.7；p < 0.003）。结论：无论中毒程度如何，单次输注 Viperfav (TM)（一瓶）都是有效的，多次注射并不能改善结果。Viperfav (TM)中毒后不久（< 10 小时）给予抗生素治疗是最有效的，常规使用皮质类固醇治疗并不能改善所选终点，我们不建议使用 LMWH，因为这会增加持续的功能不适和住院时间。
The treatment of European viper envenomings is based on IV antivenom infusions. Viperfav (TM) contains purified F(ab')(2) fragments of equine antibodies, and a 4 ml vial can neutralize 500-1000 mouse LD50 of Vipera aspis, V. ammodytes and V. berus venoms and is known to be safe and efficient. Assessments of Viperfav (TM) (dosage and timing of infusions) and of symptomatic treatments such as low-molecular-weight heparin (LWHM), corticosteroids and the routine use of antibiotic therapy have not as yet been reported. Objectives. The objective was to compare the efficacy and safety of Viperfav (TM) as a function of the time to infusion and to assess other symptomatic treatments given for European viper bites such as antibiotics, corticosteroids and LWMH. Methods. A prospective case review study of viper envenomings treated with Viperfav (TM) was compiled by the Angers Poisons Centre. The endpoints chosen were as follows: duration of hospital stay, complications (haematoma, infection) and persistent functional discomfort on day 15. Statistical studies were based on multivariate data analysis (MVA). Results. 268 moderate or severe envenomings (Grades II and III) recorded in adults and children between 1999 and 2009 were included in the study. A time to the Viperfav (TM) infusion < 10 h after the bite (179 patients vs. 72) significantly reduced the incidence of haematomas (OR 2.3; p < 0.006), functional discomfort (OR 3.7; p < 10-4) and length of hospital stay (OR 2.1; p < 0.03). Multiple doses of Viperfav (TM) (2 or 3 vials in 22 patients vs. 246 treated with 1 vial) did not improve the selected endpoints. Routine antibiotic therapy was prescribed in 102 patients (vs. 166 patients without) and no significant difference was seen with respect to the endpoints. Moreover, no local or systemic infections were recorded in the non-antibiotic group. Corticosteroids were prescribed in 36 patients (vs. 232 without) but they did not significantly improve the endpoints or oedema. LMWH in 32 patients (vs. 236 without) increased the length of hospital stay (OR 3.2; p < 0.009 and the level of significantly persistent functional discomfort at day 15 (OR 3.7; p < 0.003). Conclusions. A single infusion of Viperfav (TM) (one vial) was effective whatever the grade of envenomation, and multiple doses did not improve the outcome. Viperfav (TM) was most effective when given soon (< 10h) after envenoming. The routine use of antibiotic therapy was not necessary. Corticosteroids did not improve the endpoints selected, and we do not recommend the use of LMWH as this increased persistent functional discomfort and the length of hospital stay.