蛇蟲蜂急症.pptVIP

蜂螫的處理 吳明玲醫師 臺北榮民總醫院內科部臨床毒物科 Case 陳XX, 47 y/o male 91年11月10日2:30pm在南霸山(海拔400M)整理農地時，遭受數百隻虎頭蜂(黑腹)攻擊(蜂巢在樹上)，送至鄰近XX醫院，身上大約350個蜂螫傷口腫脹痛 於11pm轉至北榮ER，到院時意識清楚，呼吸急促，手部腫脹，oliguria PS: 另一61 y/o male,約 26個蜂螫傷口,腫脹痛 Biochemical Tests Hematological Tests Active Problem Acute renal failure Acute hepatic failure Acute pancreatitis Acute hemolysis Rhabdomyolysis DIC 蜂毒成份 (胡蜂) 蜂毒成份 (蜜蜂) Toxicological Mechanism Phospholipase A2 - hemolysin Mast cell degranulating peptides- exist in honeybee venom (MCD peptide) and in vespid venom (mastoparan) Hyaluronidase - disruption of the hyaluronic acid connective tissue matrix, allowing for spread of venom into tissue. Toxicological Mechanism Melittin (honeybee) local pain, alters membrane integrity cell surface-active agent? direct hemolysin, platelets aggregation Apamin (honeybee) profound effect on spinal cord function, causing hyperactivity, muscle spasms and seizures 毒理機轉 致死蛋白：為一種具有分解磷脂質活性的 phospholipase A1，對於血液具有溶血作用，並可引起腎衰竭、電解質異常，並進而致人於死。 組織腫脹的成份：主要為phospholipase A1, serotonin, protease, mastoparan。另外 histamine、prostaglandin E2, kinin 及其他 monoamine 也會有作用。 Mechanism of Hypersensitivity Antigenic substance: phospholipase、hyaluronidase、acid phosphatase (honeybee) 或 phospholipase A B、hyaluronidase、antigen 5 (wasp). IgE-medicated, sensitization (several days) Late-onset allergic reaction: IgG and Ig E-medicated, onset several hours to 10 days Natural Immunity When natural immunity to Hymenoptera venom develops, it is usually due to the development of large amounts of IgG antibodies which block the combination of venom antigen with IgE and prevents or lessens immunologic response 蜂的生活史 新蜂王大約從三至四月開始建立它的巢穴。 到了四，五月份蜂數增加到千餘隻。 到了九，十，十一月份時蜂群已增加到近萬隻，(此時蜂群較不穩定，一方面幼虫生產過多，食物需要量增大，但野外食物來源卻漸漸淢少，幼虫可能因發育不良而死亡，另一面有新蜂王產生，新勢力形成，使得蜂群的攻擊性變強，最容易產生螫人的情形發生) 十一月下旬蜂數漸減。 Clinical Manifestations CLINICAL EFFECTS Nonallergic Local Reaction Toxic Reaction Hypersensitivity (Local, Systemic) Late-onset allergic reactions Nonallergic Local Reaction wheal, pain,