Management of Snakebite and Systemic Envenomation in Rural Ecuador Using the 20-minute Whole Blood Clotting Test
Management of Snakebite and Systemic Envenomation in Rural Ecuador Using the 20-minute Whole Blood Clotting Test
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DOI：
10.1016/j.wem.2013.08.001
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发表时间：
2013-12-01
影响因子：
1.4
通讯作者：
Guevara, Alicia H.
中科院分区：
文献类型：
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作者：
Gaus, David P.;Herrera, Diego F.;Guevara, Alicia H.
目标。在低收入国家，蛇咬伤通常在资源严重受限的农村地区卫生中心得到处理。在这些环境中，许多医疗保健提供者获得用于诊断中毒的大量且相对昂贵的实验室研究的机会有限。相对简单和便宜的20分钟全血凝血试验（WBCT）已被一些国际组织推荐用于诊断某些毒蛇咬伤。本研究旨在证实WBCT作为唯一的实验室诊断工具在世界上资源严重匮乏地区血毒蛇咬伤管理中确定系统中毒的效用。作者使用wbtc回顾了厄瓜多尔农村一家小医院6年期间所有110例蛇咬伤病例。-所有病例均在蛇咬伤后24小时内出现。20例患者凝血正常，无系统性中毒的临床证据，90例患者20分钟无凝块形成证据（WBCT阳性），提示系统性中毒。在这90例病例中，根据分类量表，54例为轻度，26例为中度，10例为需要转至三级保健的严重中毒。所有轻度和中度全身中毒均在农村医院成功治疗。M例严重中毒患者在转入三级保健之前，最初使用抗蛇毒血清治疗。1例严重中毒患者在三级护理中死亡。- WBCT预测了我们地区蛇咬伤引起的系统性中毒的存在或不存在。WBCT指导了轻度和中度全身中毒的成功治疗，并使无全身中毒证据的患者免受抗蛇毒血清潜在副作用的影响。
Objectives.-In low-income countries, snakebites are frequently managed in rural areas in health centers with severely constrained resources. Many healthcare providers in these settings have limited access to the numerous and relatively expensive laboratory studies used to diagnose envenomation. The relatively simple and inexpensive 20-minute whole blood clotting test (WBCT) has been recommended by several international organizations for the diagnosis of certain venomous snakebites. This study proposes to confirm the utility of the WBCT as the sole laboratory diagnostic tool to determine systemic envenomation in hematotoxic snakebite management in severely resource-constrained areas of the world.Methods.-The authors reviewed all 110 cases of snakebite during a 6-year period in a small hospital in rural Ecuador using the WBCT.Results.-All cases presented within 24 hours of snakebite. Twenty cases revealed normal coagulation with no clinical evidence of systemic envenomation Ninety cases had no evidence of clot formation (positive WBCT) at 20 minutes, suggesting systemic envenomation. Of these 90 cases, according to a classification scale, 54 were mild, 26 were moderate, and 10 were severe envenomations requiring transfer to tertiary care. All mild and moderate systemic envenomations were successfully treated at the rural hospital. M severe envenomations were treated initially with antivenom before transfer to tertiary care. One patient with severe envenomation died in tertiary care.Conclusions.-The WBCT was predictive of the presence or absence of systemic envenomation from snakebite in our region. The WBCT guided the successful management of mild and moderate systemic envenomation, and spared patients with no evidence of systemic envenomation from potential side effects of antivenom.