对疑似蜘蛛咬伤患者的诊治：概述
- Authors
- Richard S Vetter, MS
Richard S Vetter, MS
- Department of Entomology
- University of California, Riverside
- David L Swanson, MD
David L Swanson, MD
- Associate Professor of Dermatology
- Mayo Clinic
- Section Editors
- Daniel F Danzl, MD
Daniel F Danzl, MD
- Section Editor — Environmental Emergencies
- Professor of Emergency Medicine
- University of Louisville School of Medicine
- Stephen J Traub, MD
Stephen J Traub, MD
- Section Editor — Toxicology
- Associate Professor of Emergency Medicine
- Mayo Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
- Translators
- 赵轶国, 主治医师
赵轶国, 主治医师
- 北京大学第一医院急诊科
引言
蜘蛛咬伤是罕见的医疗事件。在全世界现存的数千种蜘蛛中，只有少数会给人类带来麻烦[1]。许多更为常见的疾病其表现类似蜘蛛咬伤，有些如果诊断或治疗不当会给患者带来更大的威胁。
因此，准确诊断是临床医生评估可能为蜘蛛咬伤患者的首要目标。在蜘蛛咬伤的鉴别诊断中辨别各种情况需要熟悉这些疾病，还需要对有医学意义的蜘蛛分布和习性有基本的了解。
此处将总结有医学意义的蜘蛛、其咬伤的临床表现概述及蜘蛛咬伤的诊断和鉴别诊断。隐士蜘蛛和寡妇蜘蛛咬伤的评估及处理将单独讨论。 (参见“隐斜蛛咬伤”和“寡妇蜘蛛咬伤的临床表现和诊断”，关于‘临床表现’一节和“寡妇蜘蛛咬伤的处理”)
有医学意义的蜘蛛
蜘蛛属蛛形纲(节肢动物门的一组)，具有4对足，与蝎子、螨虫和蜱相似(图 1)。它们利用螯肢末端锋利的螯牙噬咬猎物(通常为昆虫、其他节肢动物或小型脊椎动物)并注射毒液。
大多数蜘蛛对人类并无威胁。大多数蜘蛛的毒液对哺乳动物组织而言作用轻微甚至无作用[2,3]。此外，只有少数种类蜘蛛具有足够强大的前螯肌肉能刺破人类的皮肤，且大多数这类蜘蛛只在极少数且极端的情况下才会咬伤人类，例如当它们夹在人类皮肤和其他物体之间受到致命的挤压时
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