儿童响尾蛇咬伤:抗蛇毒血清治疗和手术指征

B. Shaw, H. Hosalkar
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引用次数: 35

摘要

背景:在美洲工作的矫形外科医生在治疗被有毒响尾蛇(Crotalus属)咬伤的患者时可能会被咨询,特别是关于筋膜室综合征和软组织破坏的可能性。尽管有大量证据表明抗蛇毒血清在治疗成人响尾蛇咬伤中的安全性和有效性,但关于抗蛇毒血清和手术在治疗儿童响尾蛇中毒中的作用的争议仍然存在。我们的假设是,积极使用抗蛇毒血清对儿童和成人一样有效和安全。方法:回顾性分析我院连续收治的24例被西部菱形响尾蛇咬伤的病例。24名病人中有19人中毒。在审查的十年期间,由于使用了重症监护病房协议,所收集数据的一致性得到了促进。制定了一份问卷进行长期随访。结果:积极使用多价马抗蛇毒血清安全地避免了19例中毒患者中的16例需要手术。在接受手术治疗的三名患者中,两名患者进行了有限的软组织切除术,一名患者因未注射足够的抗蛇毒血清而发生筋膜室综合征而进行了腿部筋膜切开术。未发现与抗蛇毒血清相关的严重不良反应,出院时未发现功能损伤。结论:治疗儿童严重响尾蛇中毒,首选抗蛇毒血清治疗,而非手术治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Rattlesnake Bites in Children: Antivenin Treatment and Surgical Indications
Background: Orthopaedic surgeons working in the Americas may be consulted in the care of patients bitten by venomous rattlesnakes (genus Crotalus ), particularly with regard to the possibilities of compartment syndrome and soft-tissue destruction. Despite considerable evidence regarding the safety and efficacy of antivenin in the treatment of rattlesnake bites in adults, controversy persists regarding the roles of antivenin and surgery in the treatment of rattlesnake envenomations in children. Our hypothesis is that aggressive use of antivenin is just as effective and safe for children as it is for adults.Methods: We retrospectively reviewed the charts of twenty-four consecutive patients who had been managed at our hospital because of a bite from a western diamondback rattlesnake. Nineteen of the twenty-four patients had been envenomated. The uniformity of collected data was facilitated by the use of an intensive-care-unit protocol during the ten-year period that was reviewed. A questionnaire was developed for long-term follow-up.Results: Aggressive use of polyvalent equine antivenin safely prevented the need for surgery in sixteen of the nineteen envenomated patients. Of the three patients who had surgical treatment, two were managed with limited soft-tissue débridement and one was managed with a fasciotomy of the leg because of a compartment syndrome that occurred when adequate antivenin was withheld. No serious adverse effects were noted in association with the antivenin, and no functional impairments were noted at the time of discharge.Conclusion: Antivenin, rather than surgery, is the proper initial treatment of severe rattlesnake envenomations in children.
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