救治眼镜王蛇咬伤的临床报告

目的探讨眼镜王蛇咬伤中毒发病情况及合理有效的治疗方法。方法收集2008年6月~2015年6月救治的16例眼镜王蛇咬伤中毒患者的临床资料进行回顾性总结分析。抢救方法为立即伤口去毒灭毒处理,人工辅助呼吸,主要药物有抗蛇毒血清,山茛菪碱+地塞米松防治MODS,氨茶碱,新斯的明或加兰他敏。结果 16例患者治愈出院,无后遗症。结论眼镜王蛇咬伤患者较早出现中毒症状,经采取设定的方案进行治疗是有效的。     

竹叶青蛇咬伤致DIC的救治体会

目的观察中西医结合救治竹叶青蛇咬伤致DIC的疗效。方法采用抗蝮蛇毒血清结合清热解毒、凉血止血、活血化瘀的中药治疗竹叶青蛇咬伤致DIC的患者13例。结果13例患者全部治愈。结论早期应用抗蝮蛇毒血清联合中药治疗竹叶青蛇咬伤致DIC的疗效确切。     

1例眼镜王蛇咬伤致自主呼吸停止122h报告

目的探讨眼镜王蛇咬伤致呼吸停止的抢救方法。方法对患者实施局部处理,应用抗蛇毒血清及中医中药等解毒治疗,及时行机械通气、并设专人特护。结果患者自主呼吸停止122h后恢复自主呼吸,住院8天后好转出院。结论及时就医,采取正确有效的急救措施以及严密的病情观察,保持呼吸道通畅是抢救成功的决定性因素。     

眼镜王蛇咬伤致自主呼吸停止41小时抢救成功一例报告

眼镜王蛇咬伤致自主呼吸停止４１小时抢救成功一例报告伍世轰,荀建宁广西中医二附院眼镜王蛇是世界上体形最大、排毒量最多和最凶猛的一种毒蛇。据国内最新报导：眼镜王蛇咬伤致死率高达９５％以上,有咬伤后５分钟内死亡的病例报告。我院于１９９２年６月中旬用中西医结...     

中华眼镜蛇伤致局部组织损伤的临床研究

目的 探讨中华眼镜蛇咬伤致局部组织损伤的最佳治疗方法。方法 对蛇伤患者分别采用蛇伤药酒外敷、胰蛋白酶或糜蛋白酶局部封闭、抗眼镜蛇毒血清局部封闭共3种处理方法进行局部治疗,观察其疗效。结果 3种治疗方法从优到劣依次是：抗眼镜蛇毒血清局部封闭、胰蛋白酶或糜蛋白酶局部封闭、蛇伤药酒外敷。结论 中华眼镜蛇咬伤致局部组织损伤的治疗方法应首选抗眼镜蛇毒血清局部封闭,其次是胰蛋白酶或糜蛋白酶局部封闭,最差的是采用蛇伤药酒外敷。     

眼镜蛇咬伤伤口护理

目的探讨预防眼镜蛇咬伤伤口溃疡的护理方法.方法将确诊为眼镜蛇咬伤患者分为治疗组和对照组,其中治疗组23例,常规处理后,用精制抗眼镜蛇毒血清500u加甲基强的松龙40mg加5%普鲁卡因(或0.5%利多卡因)40～60ml于伤口近心端环形局部封闭后用呋喃西林湿敷;对照组20例按常规处理.结果治疗组全部病例痛觉减轻,伤口红肿大部分消退,无病例出现溃疡和溃烂,或伤口加重恶化现象,与对照组比较差异有显著性(P＜0.01).结论用精制抗眼镜蛇毒血清作伤肢环形局部封闭可减少眼镜蛇咬伤伤口溃疡、溃烂,消灭截肢致残现象.     

临床应用抗蛇毒血清皮试的体会

抗蛇毒血清是马血清制剂 ,异体蛋白对人体有过敏反应 ,传统办法是使用前必须作皮试。但皮试时有的个体会出现假阳性或假阴性反应。对蛇伤患者来说 ,即使是皮试阳性 ,为抢救患者生命 ,必须注射抗蛇毒血清。按传统的脱敏注射法既麻烦又耽误治疗时间。早在 1 973年江苏无锡崇安医院应用分段稀释滴注法治疗蛇伤患者数千例 ,均不采用皮试法 ,却安全有效。作者 1 999年至 2 0 0 0年收治毒蛇咬伤 32 5例 ,其中使用抗蛇毒血清配合中西药物辅助治疗 1 67例 (蝮蛇咬伤 1 5 6例 ,烙铁头蛇咬伤2例 ,眼镜蛇咬伤 7例 ,五步蛇咬伤 2例 ) ,为验证皮试假阳性…     

毒蛇咬伤125例临床救治分析

目的 总结毒蛇咬伤的急诊处理方法,以提高对此类患者的抢救与治疗水平. 方法 分析2005～2007年,我科收治的各类蛇咬伤患者125例的临床资料. 结果 神经毒类毒蛇咬伤患者23例,血液毒类毒蛇咬伤患者54 例,细胞毒类毒蛇咬伤患者39例,其他蛇咬伤9例.经采用局部伤口常规处理,静滴并局部封闭注射抗蛇毒血清,地塞米松、654-2(或长托宁)防治MODS等方法治疗.痊愈123例(98.4%),死亡2例(1.6%). 结论 毒蛇咬伤应予早期伤口处理、应用抗蛇毒血清、抗感染、预防并发症治疗为主,就诊时间的早晚、急救时的伤口处理是否及时得当对病情预后关系密切.     

中西医结合治疗蝰蛇咬伤75例临床体会

目的总结中西医结合抢救治疗蝰蛇咬伤的方法。方法采用抗蝮蛇毒血清和抗五步蛇毒血清配伍代替抗蝰蛇毒血清以及中西医结合综合抢救治疗蝰蛇咬伤患者75例。结果 75例患者中,治愈58例,好转13例,无效3例,死亡1例。有效率94.67%。结论在缺乏抗蝰蛇毒血清的情况下,抗蝮蛇毒血清和抗五步蛇毒血清配伍使用以及中西医结合综合抢救治疗蝰蛇咬伤能提高抢救成功率。     

竹叶青蛇咬伤中毒抗蛇毒血清的选用与优化探讨

目的 探讨竹叶青蛇咬伤治疗中抗蛇毒血清选用策略与优化.方法 收集我院157例竹叶青蛇咬伤住院患者的临床资料,依据抗蛇毒血清的使用情况分为抗五步蛇毒血清单用组(A组)、抗蝮蛇毒血清单用组(B组)、两种抗蛇毒血清联用组(C组),分析比较各组的抗蛇毒血清使用量、治疗效果及不良反应发生情况.结果 157例患者中共应用229支抗...     

毒蛇咬伤患者院前早期程序化急救处理方案的应用观察

目的探讨毒蛇咬伤患者院前早期程序化急救处理方案的应用价值。方法回顾性分析我院58例毒蛇咬伤患者应用院前早期程序化急救处理方案的临床资料。结果 58例毒蛇咬伤患者经院前早期程序化急救处理后,痊愈出院53例,好转3例,自动出院1例,院前死亡2例（眼镜王蛇咬伤1例,银环蛇咬伤1例）。结论院前急救是蛇伤治疗前期的一个关键性步骤,院前早期程序化急救处理方案应用于蛇伤患者,有利于提高抢救成功率。     

毒蛇咬伤病人的血小板聚集功能初探

目的为了探讨血液毒及混合毒类毒蛇咬伤病人的血小板功能情况,了解临床中毒发病机理。方法对近年来在本院急诊科确诊的五步蛇(Da.),蝮蛇(Ah.),眼镜蛇(Nn.),眼镜王蛇(Oh.),蝰蛇(Vr.),烙铁头(Tm.)和竹叶青(Ts.)等各种血液毒及混合毒类毒蛇咬伤17例病人25个血样,进行最大血小板聚集率(MAR)的检查和分析研究。结果除了Da未见MAR下降外(仅1例1个样品),其余各蛇种咬伤的样品均有下降。在获得未经治疗(抗蛇毒血清)的15个样品的检查结果中,进行统计分析,Vr、Tm以及Ah的MAR比正常人对照组(51.3±16.0)%明显下降。结论蛇毒中的血小板集聚抑制因子,可引起蛇伤患者体内血小板聚集功能下降,血小板处于无用状态,结果有些蛇伤病人DIC样综合征时出现严重出血而无明显微循环血栓形成致器官受损的临床症状。     

眼镜王蛇神经毒素CM—11核磁共振氢谱谱峰的完全归属

眼镜王蛇抽提物ＣＭ－１１为含７２个残基的长链神经毒素,对其进行了ＤＱＦ－ＣＯＳＹ,ＴＯＣＳＹ和ＮＯＥＳＹ等一系列２Ｄ－ＮＭＲ谱测定,借助序列专一归属法完成了ＣＭ－１１ＮＭＲ氢谱的完整归属。     

Time delays in treatment of snakebite patients in rural Sri Lanka and the need for rapid diagnostic tests

Delays in treatment seeking and antivenom administration remain problematic for snake envenoming. We aimed to describe the treatment seeking pattern and delays in admission to hospital and administration of antivenom in a cohort of authenticated snakebite patients. Adults (> 16 years), who presented with a confirmed snakebite from August 2013 to October 2014 were recruited from Anuradhapura Hospital. Demographic data, information on the circumstances of the bite, first aid, health-seeking behaviour, hospital admission, clinical features, outcomes and antivenom treatment were documented prospectively. There were 742 snakebite patients [median age: 40 years (IQR:27–51; males: 476 (64%)]. One hundred and five (14%) patients intentionally delayed treatment by a median of 45min (IQR:20-120min). Antivenom was administered a median of 230min (IQR:180–360min) post-bite, which didn’t differ between directly admitted and transferred patients; 21 (8%) receiving antivenom within 2h and 141 (55%) within 4h of the bite. However, transferred patients received antivenom sooner after admission to Anuradhapura hospital than those directly admitted (60min [IQR:30-120min] versus 120min [IQR:52-265min; p<0.0001]). A significantly greater proportion of transferred patients had features of systemic envenoming on admission compared to those directly admitted (166/212 [78%] versus 5/43 [12%]; p<0.0001), and had positive clotting tests on admission (123/212 [58%] versus 10/43 [23%]; p<0.0001). Sri Lankan snakebite patients present early to hospital, but there remains a delay until antivenom administration. This delay reflects a delay in the appearance of observable or measurable features of envenoming and a lack of reliable early diagnostic tests. Improved early antivenom treatment will require reliable, rapid diagnostics for systemic envenoming.     

龙岩市急诊蛇伤流行病学特征与综合救治

目的探讨龙岩市急诊蛇伤流行病学特征和综合救治措施。方法回顾性分析我院2006-2011年资料完整的458例蛇伤住院患者的临床资料。结果458例急诊蛇伤患者中,死亡6例,病死率1．3％,致伤蛇种以竹叶青蛇、烙铁头、眼镜蛇、银环蛇、眼镜王蛇为主,近年来还发现一些罕见蛇类如白头蝰蛇、红脖颈槽蛇咬伤病例;掌握了我市蛇伤的发病季节、致伤人群、致伤部位及转归。结论初步掌握了龙岩市急诊蛇伤流行病学特征,并提出了有效的综合救治措施,为今后开展蛇伤的防治、教学、科研提供了科学依据。     

毒蛇咬伤致急性呼吸衰竭38例救治分析

目的探讨毒蛇咬伤致急性呼吸衰竭的发病机制和治疗措施。方法选择毒蛇咬伤患者38例,应用抗蛇毒血清、机械通气等综合治疗。结果经综合救治措施治疗,38例全部痊愈出院。结论综合救治措施是抢救毒蛇咬伤致急性呼吸衰竭最有效的方法。     

Immune Response to Snake Envenoming and Treatment with Antivenom; Complement Activation,Cytokine Production and Mast Cell Degranulation

Background

Snake bite is one of the most neglected public health issues in poor rural communities worldwide. In addition to the clinical effects of envenoming, treatment with antivenom frequently causes serious adverse reactions, including hypersensitivity reactions (including anaphylaxis) and pyrogenic reactions. We aimed to investigate the immune responses to Sri Lankan snake envenoming (predominantly by Russell''s viper) and antivenom treatment.

Methodology/Principal Findings

Plasma concentrations of Interleukin (IL)-6, IL-10, tumor necrosis factor α (TNFα), soluble TNF receptor I (sTNFRI), anaphylatoxins (C3a, C4a, C5a; markers of complement activation), mast cell tryptase (MCT), and histamine were measured in 120 Sri Lankan snakebite victims, both before and after treatment with antivenom. Immune mediator concentrations were correlated with envenoming features and the severity of antivenom-induced reactions including anaphylaxis. Envenoming was associated with complement activation and increased cytokine concentrations prior to antivenom administration, which correlated with non-specific systemic symptoms of envenoming but not with coagulopathy or neurotoxicity. Typical hypersensitivity reactions to antivenom occurred in 77/120 patients (64%), satisfying criteria for a diagnosis of anaphylaxis in 57/120 (48%). Pyrogenic reactions were observed in 32/120 patients (27%). All patients had further elevations in cytokine concentrations, but not complement activation, after the administration of antivenom, whether a reaction was noted to occur or not. Patients with anaphylaxis had significantly elevated concentrations of MCT and histamine.

Conclusions/Significance

We have demonstrated that Sri Lankan snake envenoming is characterized by significant complement activation and release of inflammatory mediators. Antivenom treatment further enhances the release of inflammatory mediators in all patients, with anaphylactic reactions characterised by high levels of mast cell degranulation but not further complement activation. Anaphylaxis is probably triggered by non allergen-specific activation of mast cells and may be related to the quality of available antivenom preparations, as well as a priming effect from the immune response to the venom itself.     

Snake bite envenomation in Riyadh province of Saudi Arabia over the period (2005–2010)

The present investigation is a retrospective review of snake bites in Riyadh province over the period (2005–2010). A total of 1019 cases of bites admitted to the Ministry of Health medical centers in Riyadh province were analyzed on the basis of age, sex, time of bite and its site on the body, outcome of treatment, antiserum dose and type of snake. Bites occurred throughout the six years with the highest frequency in 2005 and least in 2006 where most of the bite cases were mild and all evolved to cure except four patients who died following the administration of antivenom during 24 h after snake bite. Most of the patients were males (81.7%) and the most attacked age was within the range of 11–30 years (51.5%). All the bites were mainly in the exposed limbs and the most frequently bitten anatomical regions were the lower limbs (427 cases, 41.9%), principally the feet. The study incriminates Cerastes cerastes gasperettii in most of the bites indicating it as the snake of medical importance in Riyadh province. Also, the study indicates low degree of threat in spite of high rate of snake bites as a result of the availability of the medical facilities and the antivenin use in medical centers in Riyadh province.     

广西眼镜王蛇毒碱性磷脂酶A_2(PLA_2)的分离纯化及其性质的研究

广西眼镜王蛇毒用羧甲基纤维素CM-52、磷酸纤维素P-11和Sepharose CL-6B柱层析纯化,得到一个在聚丙烯酰胺凝胶电泳上为单一蛋白带,PLA_2的比活性较原蛇毒提高3.6倍,分子量的为13000,由122个氨基酸组成,_pI为8.9,具有良好的热稳定性。从碱性PLA_2对红细胞影响的电镜观察可见,对人的红细胞膜有明显的作用,而对山羊红细胞作用不明显。PLA_2无论对人还是对山羊、兔和豚鼠红细胞电泳速度都有明显的迟缓作用。     

Snake Bite in South Asia: A Review

Snake bite is one of the most neglected public health issues in poor rural communities living in the tropics. Because of serious misreporting, the true worldwide burden of snake bite is not known. South Asia is the world''s most heavily affected region, due to its high population density, widespread agricultural activities, numerous venomous snake species and lack of functional snake bite control programs. Despite increasing knowledge of snake venoms'' composition and mode of action, good understanding of clinical features of envenoming and sufficient production of antivenom by Indian manufacturers, snake bite management remains unsatisfactory in this region. Field diagnostic tests for snake species identification do not exist and treatment mainly relies on the administration of antivenoms that do not cover all of the important venomous snakes of the region. Care-givers need better training and supervision, and national guidelines should be fed by evidence-based data generated by well-designed research studies. Poorly informed rural populations often apply inappropriate first-aid measures and vital time is lost before the victim is transported to a treatment centre, where cost of treatment can constitute an additional hurdle. The deficiency of snake bite management in South Asia is multi-causal and requires joint collaborative efforts from researchers, antivenom manufacturers, policy makers, public health authorities and international funders.