| 2,104 | 19 | 204 |
| 下载次数 | 被引频次 | 阅读次数 |
目前蛇咬伤的发病率和死亡率仍居高不下,各地毒蛇种类较多且蛇毒毒素成分复杂,尚缺乏快速区分毒蛇种类与蛇毒成分的有效方法。因此,对于毒蛇致伤患者的诊断和救治仍存在一定问题,近年来关于毒蛇致伤诊治方面的文献虽时有报道,但随着医疗技术的快速发展和知识的日益更新,毒蛇致伤的临床诊治方法需要更新。为此,湖北省中毒与职业病救治联盟连同国内多家医疗机构,综合相关专家的学术和临床经验起草本专家共识,并和部分毒蛇致伤高发地区的临床专家实战运用,最后提交本共识专家委员会讨论通过,就毒蛇咬伤的临床诊治规范达成共识。本文旨在帮助临床医护人员对毒蛇致伤患者做出实用可行的评估与治疗方案。
Abstract：At present, the morbidity and mortality of snakebite are still high. There are many kinds of venomous snakes in different regions and the composition of venomous venom is complex. It is not possible to quickly distinguish between the species of venomous snakes and the composition of their venom. Therefore, there still exits some problems in the diagnosis and treatment of patients injured by poisonous snakes. Although the literature on the diagnosis and treatment of venomous snake injury has been reported in recent years, the clinical diagnosis and treatment methods of poisonous snakes need to be updated, with the rapid development of medical technology and the update of knowledge. Therefore, Hubei Provincial Alliance for Treatment of Poisoning and Occupational Diseases, together with a number of domestic medical institutions, drafted this expert consensus based on the academic and clinical experience of relevant experts, and applied it with clinical experts in some areas with high incidence of venomous snake injuries. Finally, it was discussed and approved by the expert committee, and a consensus was reached on clinical practice for snakebite. The purpose of this paper is to help clinical staff to make practical and feasible evaluation and treatment plan for patients injured by poisonous snakes.
[1]Seifert S A,Armitage J O,Sanchez E E.Snake envenomation.reply[J].2022,386(1):68-78.
[2]Ren H,Malecela M N,Cooke E,et al.WHO’s Snakebite Envenoming Strategy for prevention and control[J].Lancet Glob Health,2019,7(7):e837-e838.
[3]Mukherjee K,Mackessy S P.Prevention and improvement of clinical management of snakebite in Southern Asian countries:proposed road map[J].Toxicon,2021,200:140-152.
[4]龚旭初,杨万富国内毒蛇咬伤流行病学研究现状[J].中国中医急症,2012,21(5):778-780.
[5]唐忠志,邵素花,费丹婷,等1080例蛇咬伤患者流行病学分析研究[J].华南国防医学杂志,2017,31(6):363-367.
[6]万力,张祥文,何川鄂,等鄂西宜昌及周边地区毒蛇咬伤流行病学分析[J].临床急诊杂志,2016,17(2):115-117.
[7]杨展正,张作鹏,岑青燕,等2010-2019年广州及周边地区毒蛇伤流行病学分析[J].岭南急诊医学杂志,2021,26(1):29-32.
[8]许韩波,陈晓梅,黄伟斌毒蛇咬伤患者220例临床综合治疗回顾分析[J].江西医药,2020,55(10):1460-1461.
[9]李天星,蔡婷婷,张哲.广东省阳江市近5年毒蛇咬伤流行病学分析[J].临床急诊杂志,2020,21(9):727-730.
[10]陈思雄,陈清梅,董永盛粤西茂名地区毒蛇咬伤的流行病学特征研究[J].蛇志,2021,33(1):8-9.
[11]黄培颖,曾仲意,刘强,等竹叶青蛇咬伤的流行病学调查及院前影响因素分析[J].临床急诊杂志,2020,21(5):393-396.
[12]高峰,李海燕,易丽萍杭州地区毒蛇咬伤流行病学调查[J].中国乡村医药,2020,27(8):47-48.
[13]严张仁,潘俊卿,胡香君,等近2年南昌市及周边地区毒蛇咬伤流行病学调查[J].蛇志,2020,32(1):19-22.
[14]田彪,宾文凯,周文浩,等湖南衡阳地区毒蛇咬伤流行病学分析及防治[J].蛇志,2020,32(3):280-282.
[15]尹创,匡望春,李广名.湖南省益阳市399例毒蛇咬伤流行病学分析[C]//2020中国动物致伤诊治高峰论坛论文汇编.郑州,2020:66-68.
[16]李学红,李洁,杨春芳,等普洱地区593例蛇咬伤患者流行病学分析[J].西南国防医药,2019,29(1):99-101.
[17]Tasoulis T,Isbister K.A review and database of snake venom proteomes[J].Toxins,2017,9(9):290.
[18]Oliveira L,Viegas M F,da Silva S L,et al.The chemistry of snake venom and its medicinal potential[J].Nat Rev Chem,2022,6(7):451-469.
[19]Casewell R,Wagstaff S C,Wüster W,et al.Medically important differences in snake venom composition are dictated by distinct postgenomic mechanisms[J].Proc Natl Acad Sci USA,2014,111(25):9205-9210.
[20]Casewell R,Jackson T N W,Laustsen A H,et al.Causes and consequences of snake venom variation[J].Trends Pharmacol Sci,2020,41(8):570-581.
[21]Gutiérrez M,Lomonte B.Phospholipases A2:unveiling the secrets of functionally versatile group of snake venom toxins[J].Toxicon,2013,62:27-39.
[22]Dennis A,Cao J,Hsu Y H,et al.Phospholipase A2enzymes:physical structure,biological function,disease implication,chemical inhibition,and therapeutic intervention[J].Chem Rev,2011,111(10):6130-6185.
[23]Kini M,Koh C Y.Snake venom three-finger toxins and their potential in drug development targeting cardiovascular diseases[J].Biochem Pharmacol,2020,181:114105.
[24]Kang S,Georgieva D,Genov N,et al.Enzymatic toxins from snake venom:structural characterization and mechanism of catalysis[J].FEBS J,2011,278(23):4544-4576.
[25]Falcao B,Radis-Baptista G.Crotamine and crotalicidin,membrane active peptides from crotalus durissus terrificus rattlesnake venom,and their structurally-minimized fragments for applications in medicine and biotechnology[J].Peptides,2020,126:170234.
[26]Escalante T,Ortiz N,Rucavado A,et al.Role of collagens and perlecan in microvascular stability:exploring the mechanism of capillary vessel damage by snake venom metalloproteinases[J].PLo S One,2011,6(12):e28017.
[27]Maduwage K,Isbister K.Current treatment for venom-induced consumption coagulopathy resulting from snakebite[J].PLo S Negl Trop Dis,2014,8(10):e3220.
[28]Kariyanna T,Jayarangaiah A,Kamran H,et al.Myocardial infarction after snakebite envenomation:a scoping study[J].SciFde Cardiol,2018,2(3):21.
[29]Al-Sadawi M,Mohamadpour M,Zhyvotovska A,et al.Cerebrovascular accident and snake envenomation:scoping study[J].Int Clin Res Trials.2019,4:133.
[30]Silva A,Maduwage K,Sedgwick M,et al.Neuromuscular effects of common krait (bungarus caeruleus) envenoming in Sri Lanka[J].PLo SNe gl Trop Dis,2016,10(2):e0004368.
[31]Reis P G,Botelho A F M,Novais C R,et al.Cardiotoxic effects of micrurus surinamensis (cuvier,1817)snake venom[J].Cardiovasc Toxicol,2021,21(6):462-471.
[32]Péterfi O,Boda F,SzabóZ,et al.Hypotensive snake venom components-a mini-review[J].Molecules,2019,24(15):2778.
[33]Braga R M,Jorge A R C,Marinho A D,et al.Renal effects of venoms of Mexican coral snakes Micrurus browni and Micrurus laticollaris[J].Toxicon,2020,181:45-52.
[34]Marinho D,Silveira J A M,Chaves Filho A J M,et al.Bothrops pauloensis snake venom-derived Asp-49and Lys-49 phospholipases A2 mediates acute kidney injury by oxidative stress and release of inflammatory cytokines[J].Toxicon,2021,190:31-38.
[35]曹锋生,赵慧,朱元州,等联合战伤体系临床实践指南---全球蛇伤中毒处理解读(四)[J].中国工业医学杂志,2021,34(3):281-283.
[36]杜宇,荣霞,朱元州,等联合战伤体系临床实践指南---全球蛇伤中毒处理解读(三)[J].中国工业医学杂志,2021,34(2):174-176.
[37]World Health Organization regional office for south-east Asia.Guidelines for the Management of Snakebites,2nd[D].World Health Organization,2016.
[38]Di Nicola R,Pontara A,Kass G E N,et al.Vipers of Major clinical relevance in Europe:Taxonomy,venom composition,toxicology and clinical management of human bites[J].Toxicology,2021,453:152724.
[39]朱元州,甘泉,凌瑞杰联合战伤体系临床实践指南---全球蛇伤中毒处理解读(一)[J].中国工业医学杂志,2020,33(6):558-559.
[40]张劲松,何斌,朱元州,等联合战伤体系临床实践指南---全球蛇伤中毒处理解读(二)[J].中国工业医学杂志,2021,34(1):92-93.
[41]Boels D,Hamel F,Bretaudeau Deguigne M,et al.European viper envenomings:assessment of ViperfavTMand other symptomatic treatments[J].Clin Toxicol,2012,50(3):189-196.
[42]Kang S,Moon J,Chun B.Does the traditional snakebite severity score correctly classify envenomated patients?[J].Clin Exp Emerg Med,2016,3(1):34-40.
[43]中国蛇伤救治专家共识专家组,张剑锋,赖荣德,等2018年中国蛇伤救治专家共识[J].中华急诊医学杂志,2018,27(12):1315-1322.
[44]Pucca B,Knudsen C,S Oliveira I,et al.Current knowledge on snake dry bites[J].Toxins,2020,12(11):668.
[45]张蓉,余晓刚,杨路焕,等联合战伤体系临床实践指南---全球蛇伤中毒处理解读(五)[J].中国工业医学杂志,2021,34(4):383-384.
[46]Lewis S.Nelson,Mary Ann Howland,Neal Lewin,et al.Goldfrank’s Toxicologic Emergencies,eleventh edition[M].Mc Gaw Hllr i,New Yrko,NY,USA,2019.
[47]Lindsey E,William B,Eszter M,et al.North American congress of clinical toxicology (NACCT) 2023:Two cases of hypersensitivity reactions due to North A-merican pit viper antivenom administration with confirmed elevation of lactosealpha-1,3-galactose (alphaGal) Ig E[J].Clin Toxicol,2023,61(sup2):119.
[48]Persson E,Sj?berg G K,Haines J A,et al.Poisoning severity score.Grading of acute poisoning[J].Toxicol Clin Toxicol,1998,36(3):205-213.
[49]Minghui R,Malecela N,Cooke E,Abela-Ridder B.WHO's Snakebite Envenoming Strategy for prevention and control[J].Lancet Glob Health,7(7):e837-e838.
[50]Haddad Junior V,Amorim C,Haddad Junior W T,et al.Venomous and poisonous arthropods:identification,clinical manifestations of envenomation,and treatments used in human injuries[J].Rev Soc Bras Med Trop,2015,48(6):650-657.
[51]Boyd J,Agazzi G,Svajda D,et al.Venomous snakebite in mountainous terrain:prevention and management[J].Wilderness Environ Med,2007,18(3):190-202.
基本信息:
中图分类号:R646
引用信息:
[1]朱元州 ,杜宇 ,荣霞 .毒蛇致伤临床诊治专家共识[J].巴楚医学,2023,6(04):1-13.