Complications of Bothrops, Porthidium, and Bothriechis snakebites in Colombia.: A clinical and epidemiological study of 39 cases attended in a university hospital
Complications of Bothrops, Porthidium, and Bothriechis snakebites in Colombia.: A clinical and epidemiological study of 39 cases attended in a university hospital
复制标题
DOI：
10.1016/s0041-0101(02)00104-6
复制
发表时间：
2002-08-01
期刊：
影响因子：
2.8
通讯作者：
Díaz, A
中科院分区：
文献类型：
--
作者：
Otero, R;Gutiérrez, J;Díaz, A
描述了39例Bothrops，Porthidium和Bothriechis蛇咬伤的临床和流行病学特征以及并发症。在一年期间，病人在安蒂奥基亚和乔科的25家医院住院，然后被转到麦德林的圣维森特德保罗大学医院，其中30人是因为出现并发症，8人是因为缺乏抗蛇毒血清，还有一人是因为亲属的要求。其中男性31例（79.5%），儿童13例（33.3%），下肢咬伤占59%，尤以棘吻龙咬伤为主（74.4%）。21名（53.8%）患者最初由传统治疗师治疗，87.2%的患者在2小时后到当地医院就医。水肿（100%）、出血（74.4%）、水疱（38.5%）和坏死（38.5%）是毒液蛰入的局部表现，而凝血功能改变（79.5%）、血尿（74.4%）、牙龈出血（43.6%）、低血容量性休克（23.1%）和少尿（23.1%）是毒液蛰入的全身表现。29例患者（74.4%）的最终等级为重度毒液蛰入。30例患者（76.9%）出现一种或多种毒液扎入并发症：急性肾衰竭（ARF），15例（38.5%）;软组织感染，12例（30.8%）;中枢神经系统（CNS）出血，5例（12.8%）;筋膜室综合征，3例（7.7%）;软组织血肿，6例（15.4%）;胎盘早剥，1例（2.6%）。有4例死亡（10.3%），2例死于ARF，2例死于脑出血。其他14例患者（35.9%）有后遗症。咬伤后2小时开始血清治疗与ARF和CNS出血的发生相关（p = 0.02），以及死亡和后遗症的风险（RR = 2.5）。(C)2002爱思唯尔科技有限公司。保留所有权利。
The clinical and epidemiological features, as well as complications presented by 39 patients with Bothrops, Porthidium and Bothriechis snakebites, are described. Patients were admitted during 1 year in 25 hospitals of Antioquia and Choco and then, they were transferred to the Hospital Universitario San Vicente de Paul in Medellin, 30 of them because of the presence of complications, eight because of lack of antivenoms and another one because of the desire of his relatives. Thirty-one (79.5%) of the patients were male, 13 (33.3%) children, 59% of them were bitten at the lower extremities, the majority (74.4%) by Bothrops asper. Twenty-one (53.8%) of the patients were initially attended by traditional healers and sought medical attention at the local hospitals after 2 h in 87.2% of the cases. Edema (100%), hemorrhage (74.4%), blistering (38.5%) and necrosis (38.5%), were the local signs of envenomation, while blood coagulation alteration (79.5%), hematuria (74.4%), gingival bleeding (43.6%), hypovolemic shock (23.1%) and oliguria (23.1%), were the systemic signs of envenomation. The final grade of envenomation was severe in 29 patients (74.4%). Thirty patients (76.9%) had one or more complications of the envenomation: acute renal failure (ARF), 15 (38.5%); soft-tissue infection, 12 (30.8%); central nervous system (CNS) hemorrhage, 5 (12.8%); compartment syndrome, 3 (7.7%); soft-tissue hematomas, 6 (15.4%); and Abruptio placentae, one (2.6%). There were four deaths (10.3%), two from ARF and two from cerebral hemorrhage. Fourteen other patients (35.9%) had sequelae. The onset of serotherapy after 2 h of the bite was associated with the occurrence of ARF and CNS hemorrhage (p = 0.02), as well as the risk of death and sequelae (RR = 2.5). (C) 2002 Elsevier Science Ltd. All rights reserved.