小孩毒蛇咬傷的治療經驗

Treatment of Poisonous Snakebites in Children

10.6440/TZUCMJ.199912.0379

李俊達(Jiunn-Tat Lee)；簡守信(Sou-Hsin Chien)；孫宗伯(Tzong-Bor Sun)

小孩的毒蛇咬傷 ； 蛇毒素作用 ； 抗蛇毒血清 ； snakebites in children ； envenomation ； antivenin

慈濟醫學雜誌

11卷4期（1999 / 12 / 01）

379 - 384

繁體中文

小孩毒蛇咬傷很少見。慈濟醫院從民國76年1月到85年12月，10年間治療未滿12歲且體重小於40公斤的小孩的毒蛇咬傷共12例。毒蛇種類：龜殼花5例、飯匙倩2例、赤尾鮐1例、不明種類4例。蛇毒素作用分級(grade of envenomation)：第一級2例、第二級8例、第三級2例。無任何病人做傷口的切除療法(excisional therapy)。有11例(92%)病人接受抗蛇毒血清注射。4例(33%)病人有全身性的蛇毒素作用。4例(33%)病人需進一步手術：1例筋膜切開術及植皮、3例傷口清創及植皮。1例(9%)病人出現血清病。所有病人皆存活，且無後遺症。有鑑於小孩毒蛇咬傷病況較嚴重：83%屬於第二、三級，且有33%需要進一步手術；所有應視之為外科急症(surgical emergency)。建議的治療原則是：儘早的做傷口切除，然後視臨床反應加上蛇毒血清治療。另外因血清的病的發生率不高(9%)，故對於抗蛇毒血清的使用原則可適度放寬，且劑量加大。(慈濟醫學 1999; 11:379-384)

Poisonous snakebites in children are uncommon. During a 10-year period from January 1987 through December 1996, 12 children≤12 years old were treated at Buddhist Tzu-Chi General Hospital for snakebites. There were 5 Trimeresurus mucrosquamatus bites, 2 Naja naja atra bites, 1 Trimeresurus gramineus bite, and 4 unidentified bites. Two patients had grade I envenomation, 8 had grade II and 2 had grade III. Eleven (92%) patients received antivenin and no patient had excision of the wound in this series. Four (33%) patients had systemic envenomation. Four (33%) patients required further surgery: one had a fasciotomy and subsequent skin graft, and the other three had wound debridements and subsequent skin grafts. Only one (9%) of the 11 patienets who received antivenin developed serum sickness. There were no deaths and no long-term morbidity. From our experience, and because severe envenomation usually develops in children with poisonous snakebites, the disease should be regarded a surgical emergency. We strongly recommend early excision of the wound and antivenin given according to the severity of the clinical symptoms and signs. The amount of antivenin may be increased to double the adult dose.(Tzu Chi Med J 1999; 11:379-384)