マムシ咬傷後の高度腫脹に対する減張切開の効果

概要

論文の詳細を見る
Even in recent years there have been reports of multiple organ failure or death from the bite of a mamushi pit viper. In August 1989 we encountered a 68-year-old man who had marked swelling over an area extending from the lower extremities to the trunk after he was bitten by a mamushi pit viper. Conservative treatment was employed for the patient, it seemed to be successful, however, suddenly he developed sepsis on the 13th hospital day and died on 15th day. If relief incision had been performed, the number of complications probably would have been lower than it was. During the subsequent one-year period 9 cases of mamushi pit viper bites were experienced. Four out of the 9 patients with marked swelling were treated by relief incision, and three of the 4 had no secondary disease or complication. Immediately after the relief incision, swelling began to diminish in 3 of the 4 patients. One patient bitten in the hand developed swelling extending to the chest and neck, causing dyspnea. Mamushi antitoxin was administered to only one of the 4 patients treated by relief incision. The relief incision enabled easy discharge of the edmatous fluid induced by mamushi poison, leading to prevention of a secondary disorder, compartment syndrome. When edema invades the forearms or thighs causing swelling, and numbness, and pain in the peripheral side are severe, relief incision should be performed.
日本臨床外科学会の論文