Study on the Antivenom Treatment and Prognosis of Patients with Crotaline Snake Envenoming in Taiwan

• Main Authors: Yen-Chia Chen, 陳燕嘉
• Other Authors: Chen-Chang Yang
• Format: Others
• Language: zh-TW
• Published: 2007
• Online Access: http://ndltd.ncl.edu.tw/handle/58980957833680073670

碩士 === 國立陽明大學 === 急重症醫學研究所 === 95 === Abstract Background/Purpose: Crotaline snakebite (Protobothrops mucrosquamatus and Trimeresurus stejnegeri stejnegeri) is a common medical emergency in Taiwan. The specific antivenom to such snakebites is equine-derived bivalent F(ab’)2. We investigated the differences in clinical outcomes between patients who received antivenom dose recommended by the poison control center (medical group) and patients who received different therapeutic regimen of antivenom (surgical group) in a medical center. Methods: We conducted a retrospective cohort study by reviewing medical records of patients with crotaline snakebite between 1991 and 2005. We used a structured questionnaire to abstract information on demographic variables, treatment, adverse effects of antivenom, and local/ systemic complications. T-test, chi-squared test, and multiple logistic regression were employed in data analyses. Results: One hundred and seventy-nine patients (89 surgical, 90 medical) were eligible for the study. There was no significant difference in demographic characteristics between surgical and medical patients. The average dose of antivenom and the probability of antibiotic use were both significantly higher in the surgical group as compared to the medical group (5.9±4.2 vials versus 2.7±1.6 vials; 93% versus 60%). Multiple logistic regression that was adjusted for age, gender, calendar year of envenoming, severity of envenoming, and antibiotic use revealed no significant difference in the occurrence of life-threatening complications, milder local or systemic complications, and adverse reactions to antivenom between the two groups. Conclusions: We did not find evidence of differences in various clinical outcomes between medical and surgical patients who received different antivenom treatments. Lower dose of antivenom recommended by the poison control center is probably as effective and safe as higher dose used in the surgical group for the treatment of crotaline snakebites.