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頁籤選單縮合
題 名 | 毒蛇咬傷在臺灣=Poisonous Snakebites in Taiwan |
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作 者 | 陳發魁; | 書刊名 | 內科學誌 |
卷 期 | 10:2 1999.04[民88.04] |
頁 次 | 頁49-57 |
分類號 | 418.735 |
關鍵詞 | 毒蛇咬傷; 蛇毒中毒; 咬痕; 抗蛇毒血清; 臺灣; Poisonous snakebite; Envenomation; Teeth marks; Antivenin; Taiwan; |
語 文 | 英文(English) |
中文摘要 | 在臺灣地區共有六種毒蛇,其中有兩種神經性毒蛇,即飯匙倩及雨傘節;有四種 出血性毒蛇,即龜殼花、赤尾鮐、百步蛇及鎖鏈蛇。百步蛇及鎖鏈蛇分佈於臺灣的南部及中 部,其他四種毒蛇分佈於全省。在臺灣共有四種抗蛇毒血清,即:(1)抗雨傘節及飯匙倩蛇毒 血清。(2)抗龜殼花及赤尾鮐蛇毒血清。(3)抗百步蛇蛇毒血清。(4)抗鎖鏈蛇蛇毒血清。 在臺灣每年被毒蛇咬傷的約有300-500人,其中85%是被出血性毒蛇咬傷的,引起死亡 的約有20-30人。臨床醫師面對被毒蛇咬傷的患者,必須經過審慎的鑑別診斷,才能注射適 合的抗蛇毒血清。鑑別診斷要依據咬痕、臨床症狀及檢驗結果。 在野外「切開放毒」的動作,常常引起嚴重的細菌感染,不但使傷口難癒,也有引起敗 血症的危機。希望一般人不要做,除非:(1)在咬傷後5分鐘以內由有經驗的人操作,或(2) 路途遙遠,半小時內不能送達醫院的患者。局部冷敷、熱敷、用酒精消毒傷口都是有害的, 應予禁止。繃帶包紮,目的在抑制毒液自淋巴吸收及擴散,已經證實有效。目前每一種蛇毒 中毒,都有專用的抗蛇毒血清,但特別強調的有:(1)愈早注射,效果愈好。(2)避免注射錯 誤。(3)靜脈注射效果最好。(4)局部注射只限於咬傷後2小時以內的患者。 約有15%的患者,對抗蛇毒血清有過敏反應,但因為沒有其他的藥物能代替抗蛇毒血清, 因此對於有過敏反應的患者,利用抗組織胺及類固醇的協助,仍然要設法注入,才能解毒。 |
英文摘要 | There are six species of venomous snakes in Taiwan. Among them, two species induce neurotoxic symptoms such as (1)Naja naja atra (N.A.), (2)Bungarus multicinctus (B.M.), four species induce hemorrhagic symptoms such as (1) Trimeresurus mucrosquamatus (T. M.), (2) Trimeresurus stejnegeri (T. S,), (3) Agkistrodon acutus (A.A.), and (4) Vipera russelli formosensis (V.R.). A.A. and V.R. inhabit in southern and central Taiwan, others inhabit over the whole island of Taiwan. There are four kinds of antivenins in Taiwan: (1) Antivenin of B. multicinctus and N. naja atra, (2) Antivenin of Tr. Mucrosquamatus and Tr. Stejnegeri, (3) Antivenin of A. acutus, (4) Antivenin of V. russelli formosensis. Among 300-500 persons bitten by venomous snake a year in Taiwan, about 85% of the victims are bitten by the hemorrhagic snakes. About 20-30 cases expired. The most important work of clinical physician is differential diagnosis. The best differential diagnosis comes from (1) teeth marks, (2) clinical symptoms, and (3) laboratory data. Incision and suction are contraindicated unless performed by experienced personnel within 5 minutes of the bite or unless transport of the patient to hospital will take more than 30 minutes. Local cryotherapy, thermotherapy or use of alcohol is contraindicated. Constriction bands for limited absorption and spread in the lymphatics proved very useful. Each envenomation in Taiwan has its specific antivenin. The following four points should be kept in mind: (1) Administer the antivenin injection the earlier the best. (2) Avoid administration of inadequate antivenin. (3) Antivenin is more effective when administered intravenously. (4) Local injection only indicated in the case within 2 hours of the bite. About 15% victims are allergic to antivenin. In these cases, antivenin injection should be administrated with the help of antihistamine and steroid. |
本系統中英文摘要資訊取自各篇刊載內容。