Profile of snakebite envenoming in western Maharashtra, India
Profile of snakebite envenoming in western Maharashtra, India
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DOI：
10.1016/s0035-9203(02)90250-6
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发表时间：
2002-01-01
影响因子：
2.2
通讯作者：
Bawaskar, PH
中科院分区：
文献类型：
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作者：
Bawaskar, HS;Bawaskar, PH
1998年1月至2001年1月，印度西部马哈拉施特拉邦孟买以南180公里处的马哈德总医院收治了91例蛇咬伤病例。29例（31.9%）患者入院时携带了造成咬伤的蛇（20条金环蛇，9条棘蛇）。45例（49-5%）患者有蛇咬伤，无毒液中毒; 27例患者有局部牙痕，无局部和全身表现; 18例在咬伤后24小时报告，有局部水肿。26例（28-6%）患者瘫痪。在午夜至08：00之间报告的25例病例没有显示出中毒的局部迹象。1例患者于16：00报告，局部水肿伴水泡，有眼镜蛇咬伤史。10例（11.0%）患者死亡：3例在送往医院途中，7例在治疗期间。在7例被转移到三级护理的病例中，6例康复，我在去孟买的路上死亡。早期应用抗蛇毒血清（ASV）、气管内插管、及时人工呼吸（Ambu bag）和抗胆碱酯酶治疗是挽救眼镜蛇（Krait and cobra）中毒患者生命的关键。毒蛇咬伤的临床确认是通过鉴定受害者带来的死蛇和临床体征和症状，如麻痹（金环蛇和眼镜蛇）和快速进行性局部水肿伴活动性出血（E。carinatus和Russell's viper）。20分钟全血凝固试验是一种简便、快速、可靠的凝血功能检查方法。它还可用于评估ASV的有效性，并且对于控制与恢复血液凝固性相关的昂贵ASV的给药至关重要。
Ninety-one cases of snakebite were admitted between January 1998 and January 2001 to the general hospital at Mahad, 180 km south of Mumbai in western Maharashtra, India. Twenty-nine (31.9%) patients, when admitted to hospital, brought the snakes responsible for the bites (20 kraits, 9 Echis carinatus). Forty-five (49-5%) patients had snakebite without envenoming; 27 patients had local fang marks without local and systemic manifestations; 18, reporting 24 h after the bite, had local oedema. Twenty-six (28-6%) patients were paralysed. Twenty-five cases who reported between midnight and 08:00 showed no local signs of envenoming. One patient, who reported at 16:00, had local oedema with blebs and a history of cobra bite. Ten (11.0%) patients died: 3 on the way to hospital and 7 during treatment. Out of 7 cases transferred for tertiary care, 6 recovered and I died on the way to Mumbai. Early administration of anti-snake venom (ASV), endotracheal intubation and timely intervention with manual ventilation by Ambu bag and anticholinesterase treatment for Elapidae (krait and cobra) envenoming are crucial for saving lives. Clinical confirmation of snakebite with envenoming was by identification of the dead snake brought by victims and by clinical signs and symptoms such as paralysis (krait and cobra) and rapid progressive local oedema with active bleeding (E. carinatus and Russell's viper). The 20-min whole blood clotting test is a simple, rapid and reliable test of coagulopathy. It is also of use in assessing the effectiveness of ASV and is of crucial importance for controlling administration of expensive ASV in relation to restoration of blood coagulability.