Snake bite in South Asia: a review.

Snake bite in South Asia: a review.
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南亚的蛇咬人:评论。

DOI:
10.1371/journal.pntd.0000603
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发表时间:
2010-01-26
影响因子:
3.8
通讯作者:
Chappuis F
Chappuis F
中科院分区:
医学2区
文献类型:
--
作者:
Alirol E;Sharma SK;Bawaskar HS;Kuch U;Chappuis F

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蛇咬伤是生活在热带地区的贫困农村社区最被忽视的公共卫生问题之一。由于严重的误报,世界范围内蛇咬伤的真实负担尚不清楚。南亚是世界上受影响最严重的地区,由于其人口密度高,农业活动广泛,毒蛇种类众多,缺乏有效的蛇咬伤控制计划。尽管印度制造商对蛇毒的成分和作用方式有了越来越多的了解,对蛇毒中毒的临床特征有了很好的理解,并生产了足够的抗蛇毒血清,但该地区的蛇咬伤管理仍然不能令人满意。目前还没有用于蛇种鉴定的实地诊断试验,治疗主要依靠服用抗蛇毒血清,但这种血清并不包括该地区所有重要的毒蛇。护理人员需要得到更好的培训和监督,国家指导方针应该以精心设计的研究所产生的循证数据为依据。不了解情况的农村人口往往采取不适当的急救措施,受害者在被送往治疗中心之前失去了重要的时间,在那里治疗费用可能构成额外的障碍。南亚蛇咬伤管理的不足是多方面原因造成的,需要研究人员、抗蛇毒血清制造商、政策制定者、公共卫生当局和国际资助者的共同合作。
Snake bite is one of the most neglected public health issues in poor rural communities living in the tropics. Because of serious misreporting, the true worldwide burden of snake bite is not known. South Asia is the world's most heavily affected region, due to its high population density, widespread agricultural activities, numerous venomous snake species and lack of functional snake bite control programs. Despite increasing knowledge of snake venoms' composition and mode of action, good understanding of clinical features of envenoming and sufficient production of antivenom by Indian manufacturers, snake bite management remains unsatisfactory in this region. Field diagnostic tests for snake species identification do not exist and treatment mainly relies on the administration of antivenoms that do not cover all of the important venomous snakes of the region. Care-givers need better training and supervision, and national guidelines should be fed by evidence-based data generated by well-designed research studies. Poorly informed rural populations often apply inappropriate first-aid measures and vital time is lost before the victim is transported to a treatment centre, where cost of treatment can constitute an additional hurdle. The deficiency of snake bite management in South Asia is multi-causal and requires joint collaborative efforts from researchers, antivenom manufacturers, policy makers, public health authorities and international funders.
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