雨傘節蛇咬引起的神經肌肉症候群：台東地區醫院的個案報告

Neuromuscular Syndrome Caused by Bungarus Multicinctus Snakebite: A Case Report in a Regional Hospital in Taitung County

雨傘節咬傷的傷口特性是無痛且外觀無毒性反應症狀。醫師給予抗毒蛇血清是依據蛇的種類、蛇咬痕、以及早期組織壞死症狀，如水泡、流血、水腫併發紅。如果沒看到蛇，或無法認蛇的種類，可能會延遲診斷及注射抗毒蛇血清。病人狀況快速惡化而需要氣管插管治療。早期的神經毒性症候群包括：雙眼無法掙開、複視或牙關緊閉，皆需密切關注。若病人有全身神經毒性症狀，必需給三至四支抗毒蛇血清治療。本個案發現毒蛇咬傷並在一小時內給予三劑抗毒蛇血清，唯病人仍發生神經毒性徴候群。幸運的是病人於治療六天後完全恢復且無需使用呼吸器。

In terms of venomous bite caused by Bungarus multicinctus, the characteristic wounds are painless and even without any signs of envenoming. Many emergency physicians give patients antivenom based on snake identification, fang marks and early signs of tissue necrosis, e.g., blistering, bleeding, swelling or redness. If the bites were not witnessed or unable to describe the snake species, there might be delay in diagnosis and initiation of antivenom injection. The patients’condition may deteriorate rapidly, leading to mechanical ventilation use. Earliest signs of neurotoxic envenoming such as ptosis, diplopia or early restriction in mouth opening should be closely monitored. An optimal dosing (3 to 4 vials) of antivenom is recommended for patients with definite systemic or local signs of envenoming. We report a case with obvious fang marks suffering from neuromuscular syndrome even after three vials of antivenom given within one hour. Fortunately, his general conditions recovered after 6 days of intensive care without mechanical respiratory support.