2013至2023年間臺灣毒蛇咬傷流行病學研究：以中部某醫學中心為例

研究目的： 毒蛇咬傷為罕見急性疾病之一，多見於熱帶與亞熱帶地區，臺灣近年毒蛇咬傷率較過去下降許多，但在某些區域，蛇傷仍為重大公共衛生問題，民眾對其相關危險性和處置仍舊缺乏，過往研究多為探討部分毒蛇種類差異、手術風險因子及其他區域性流行病學，對於咬傷後併發症與實驗室檢驗結果之探討則相對有限。因此，本研究欲探討10年間臺灣中部地區毒蛇咬傷流行病學，希冀能為臨床診斷提供數據及作為制定防治策略之參考依據。研究方法： 本研究回溯性分析2013年至2023年間因毒蛇咬傷至醫院急診就醫，經臨床主治醫師診斷為毒蛇咬傷患者並登綠於中毒資料庫，共計173位毒蛇咬傷患者。方法為透過資料統計進行描述性與推論性統計，分析毒蛇咬傷患者基本特質、臨床特徵、住院治療管理及生化檢驗之差異。為探討影響生化檢驗數據之因子，使用一般線性模型（General linear mod-el, GLM）進行分析，並計算迴歸係數及其信賴區間。為探討發生併發症與接受手術之風險因子，使用羅吉斯迴歸（Logistic regression, LR）調整干擾因子，得出各變項校正後勝算比（Adjusted odds ratio, AOR）及其95%信賴區間（Confidence interval, CI）。研究結果： 本研究結果涵蓋出血性(N=97)與神經性(N=76)毒蛇咬傷患者的社會人口學、臨床特徵、住院管理治療與生化檢驗結果。結果顯示，出血性毒蛇咬傷以局部症狀為主，多為腫脹(93%)與疼痛(85%)；神經性毒蛇咬傷則與壞死(44%)、腸胃道症狀(22%)等表現相關。一般線性模型結果顯示，年齡、性別、毒蛇類型及臨床表現均影響血液、生化檢驗改變(p<0.05)。羅吉斯迴歸結果發現，出血性毒蛇咬傷(OR=6.2，95%CI 1.74–22.09 )和發燒超過38度(OR=4.94，95%CI 1.13–21.63)為白血球增多症風險因子；男性(OR=5.24，95%CI 1.06–25.71)和腸胃道症狀(OR=6.38，95%CI 1.1–36.78)為腎功能異常風險因子；出現水疱(OR=5.98，95%CI 1.11–32.1)和腸胃道症狀(OR=47.23，95%CI 2.54–878.35)為橫紋肌溶解症風險因子；傷口腫脹(OR=0.2，95%CI 0.05–0.85)則為低血鈉症風險因子。 在次群體分析，4種毒蛇在社會人口學、臨床表現、住院管理治療和生化檢驗等項目之間存在差異(p<0.05)。根據羅吉斯迴歸結果，咬傷至施打第一劑正確抗蛇毒血清時間間隔(OR=1.09，95%CI 1.002–1.19)為白血球增多症風險因子。年齡增加 (OR=1.05，95%CI 1.01–1.1)、 男性(OR=8.44，95%CI 1.26–56.33)和腸胃道症狀(OR=5.38，95%CI 1.24–23.33)為腎功能異常風險因子。抗出血性蛇毒血清總劑量(OR=1.31，95%CI 1.04–1.64)則為橫紋肌溶解症風險因子。凝血功能障礙和低血鈉症雖在4種毒蛇之間無顯著差異(p>0.05)，但仍需注意。此外，傷口壞死(OR=4.67，95%CI 1.59–13.72)和抗神經性蛇毒血清總劑量(OR=1.23，95%CI 1.1–1.38)為接受手術風險因子。結論： 本研究針對2013至2023年間臺灣中部地區毒蛇咬傷患者進行回溯性分析，結果顯示毒蛇咬傷在中部地區仍具重要臨床影響。出血性毒蛇咬傷以局部腫脹(93%)、疼痛(85%)等症狀為主，嚴重併發症較少；相較之下，神經性毒蛇咬傷則易引發傷口壞死(44%)、腸胃道症狀(22%)、發燒(27.6%)與較長住院時間(11.8天，IQR: 0.8–25.1天），病程更為嚴重。統計分析顯示，年齡、性別、毒蛇種類及臨床表現均影響血液及生化指標異常(p<0.05)。危險因子如出血性毒蛇咬傷、咬傷至施打第一劑正確抗蛇毒血清時間間隔、年齡增加、男性、出現腸胃道症狀或傷口壞死，皆可能顯著提高併發症發生率及手術治療需求之風險(p<0.05)。綜上所述，本研究結果不只補齊中部地區毒蛇咬傷流行病學數據外，也有助於提升臨床對毒蛇咬傷風險分層及病情嚴重度判斷之準確性，並可作為區域性毒蛇咬傷防治與教育推廣之重要參考依據。

Objective: Snakebite envenomation is a relatively rare but serious acute medical con-dition, mainly occurring in tropical and subtropical regions. There are six medically important venomous snakes in Taiwan, including Trimeresurus stejnegeri stejnegeri, Protobothrops mucrosquamatus, Deinagkistrodon acutus, Daboia siamensis, Naja atra, and Bungarus multicinctus. Although the inci-dence of snakebites has declined in Taiwan, it remains an important public health issue in certain areas. Previous studies have primarily focused on spe-cific snake species, surgical risk factors, or regional epidemiological patterns, with limited research addressing associated complications and laboratory find-ings. Therefore, this study aims to investigate the epidemiological characteris-tics of snakebite envenomation in central Taiwan over the past decade, with the goal of providing clinical data to enhance diagnostic accuracy and serve as a reference for developing prevention and management strategies.Material and method: This retrospective study reviewed 173 cases of snakebite envenomation presented to the emergency department between 2013 and 2023, diagnosed by clinical physicians and recorded in the toxicology database. Descriptive and inferential statistics were used to analyze sociodemographic data, clinical characteristics, hospital management, and biochemical laboratory results. A General Linear Model (GLM) was used to identify factors influencing labora-tory values, with regression coefficients and 95% confidence intervals calcu-lated. Logistic regression was used to determine adjusted odds ratios (aORs) for risk factors associated with complications and surgical interventions.Results: Among the 173 patients, hemotoxic snakebites (N=97) were primarily as-sociated with local symptoms such as swelling (93%) and pain (85%), where-as neurotoxic snakebites (N=76) were more frequently linked to wound necro-sis (44%) and gastrointestinal effects (22%). GLM analysis revealed that age, sex, snake species, and clinical presentations significantly affected hematolog-ical and biochemical abnormalities (p<0.05). Logistic regression identified hemotoxic snake envenomation and fever≧38°C as risk factors for leukocyto-sis (OR=6.2, 95% CI 1.74-22.09; OR=4.94, 95% CI 1.13-21.63, respective-ly). Male and gastrointestinal effects were associated with Acute Renal Injury (OR=5.24, 95% CI 1.06-25.71; OR=6.38, 95% CI 1.1-36.78, respectively), while blister and gastrointestinal effects increased the risk of rhabdomyolysis (OR=5.98, 95% CI 1.11-32.1; OR=47.23, 95% CI 2.54-878.35, respectively). Wound swelling was inversely associated with hyponatremia (OR=0.2, 95% CI 0.05-0.85). Subgroup analysis showed significant differences in sociodemographic characteristics, clinical manifestations, hospital management, and biochemical findings among the four snake species (p<0.05). According to logistic regres-sion analysis, bite to first correct antivenom in hours was a predictor of leuko-cytosis (OR=1.09, 95% CI 1.002-1.19), while age increased, male and gastro-intestinal effects were risk factors for Acute Renal Injury (OR=1.05, 95% CI 1.01-1.10; OR=8.44, 95% CI 1.26-56.33; OR=5.38, 95% CI 1.24-23.33, re-spectively). The total hemorrhagic antivenom dose in vials (OR=1.31, 95% CI 1.04-1.64) was significantly associated with a higher risk of rhabdomyolysis. Although coagulopathy and hyponatremia did not significantly differ by snake species (p>0.05), these complications remain clinically relevant. Lastly, wound necrosis and the total dose of neurotoxic antivenom in vials were sig-nificant predictors for surgical intervention (OR=4.67, 95% CI 1.59-13.72; OR=1.23, 95% CI 1.10-1.38, respectively).Conclusions: This 10-year retrospective analysis confirms that snake envenomation continues to pose a clinical burden in central Taiwan. Hemotoxic bites are usually associated with milder symptoms and fewer complications, while neu-rotoxic bites tend to lead to more severe outcomes such as wound necrosis, gastrointestinal effects, fever (28%), and prolonged hospitalization (IQR: 0.8-25.1 days). Age, gender, snake species, and clinical manifestations were signif-icantly associated with laboratory abnormalities. Key risk factors—including hemotoxic snake bites, bite to first correct antivenom in hours, age increased, male, gastrointestinal effects, and wound necrosis-were significantly linked to higher rates of complications and surgical intervention. These findings enrich the regional epidemiological understanding of snakebite envenomation and enhance clinical accuracy in risk stratification and severity assessment, sup-porting the development of targeted prevention and education strategies.