Snakebite: When the Human Touch Becomes a Bad Touch.
Snakebite: When the Human Touch Becomes a Bad Touch.
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DOI：
10.3390/toxins10040170
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发表时间：
2018-04-21
期刊：
影响因子：
4.2
通讯作者：
Fry BG
中科院分区：
文献类型：
--
作者：
Fry BG
蛇咬伤治疗中的许多问题和并发症是由于人类社会、经济和临床干预和管理不善造成的。因此，在减少发病率和提高患者预后方面仍有显著改进的余地。蛇并不以人类为猎物，但随着我们的住所和农场不断扩大，气候变化增加了蛇的活动周期，与蛇的意外相遇和猎物急剧增加。尽管蛇咬危机历史悠久，但它被忽视、忽视、低估和根本上被误解。每年有数万人死于蛇咬伤，数十万人将在某种形式的永久性损害和工作能力减少的情况下幸存下来。这些数字被公认为严重低估，因为在一些受影响最严重的地区，记录保存得很差，甚至根本没有记录。这些低估使正确认识蛇咬伤的社会经济影响变得更加复杂，从而使帮助缓解这场全球危机的外国援助变得更加复杂。抗蛇毒血清价格昂贵，医院寥寥无几，人们只能向传统的治疗师寻求帮助，或使用其他形式的无效治疗。在某些情况下，尽管没有证据表明它们的有效性，但仍使用了来自其他地区的廉价、不适当制造的抗蛇毒血清，通常强有力的数据表明，它们在中和许多销售它们的毒液方面效果非常差。不适当的急救和治疗包括割伤、止血带、电击、浸泡在冰水中，以及传统治疗师使用无效的草药疗法。即使在发达国家，也存在根本性的争议，包括筋膜切开术、压力绷带、抗蛇毒血清剂量、肾上腺素等预先用药，以及在宠物贸易中缺乏针对外来蛇咬伤的抗蛇毒血清。这篇综述探讨了影响全球蛇咬伤原因和治疗失败轨迹的无数人为因素，并说明蛇咬伤既是一个医学问题，也是一个社会和经济问题。因此，减少这种可控因素的发生率和频率是帮助减轻全球蛇咬负担的现实目标，因为若干领域的逐步改善将产生强大的累积效应。
Many issues and complications in treating snakebite are a result of poor human social, economic and clinical intervention and management. As such, there is scope for significant improvements for reducing incidence and increasing patient outcomes. Snakes do not target humans as prey, but as our dwellings and farms expand ever farther and climate change increases snake activity periods, accidental encounters with snakes seeking water and prey increase drastically. Despite its long history, the snakebite crisis is neglected, ignored, underestimated and fundamentally misunderstood. Tens of thousands of lives are lost to snakebites each year and hundreds of thousands of people will survive with some form of permanent damage and reduced work capacity. These numbers are well recognized as being gross underestimations due to poor to non-existent record keeping in some of the most affected areas. These underestimations complicate achieving the proper recognition of snakebite’s socioeconomic impact and thus securing foreign aid to help alleviate this global crisis. Antivenoms are expensive and hospitals are few and far between, leaving people to seek help from traditional healers or use other forms of ineffective treatment. In some cases, cheaper, inappropriately manufactured antivenom from other regions is used despite no evidence for their efficacy, with often robust data demonstrating they are woefully ineffective in neutralizing many venoms for which they are marketed for. Inappropriate first-aid and treatments include cutting the wound, tourniquets, electrical shock, immersion in ice water, and use of ineffective herbal remedies by traditional healers. Even in the developed world, there are fundamental controversies including fasciotomy, pressure bandages, antivenom dosage, premedication such as adrenalin, and lack of antivenom for exotic snakebites in the pet trade. This review explores the myriad of human-origin factors that influence the trajectory of global snakebite causes and treatment failures and illustrate that snakebite is as much a sociological and economic problem as it is a medical one. Reducing the incidence and frequency of such controllable factors are therefore realistic targets to help alleviate the global snakebite burden as incremental improvements across several areas will have a strong cumulative effect.
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