Silveira P V, Nishioka S de A
Centro de Ciências Biomédicas, Universidade Federal de Uberlândia, Brazil.
Trans R Soc Trop Med Hyg. 1992 Sep-Oct;86(5):562-4. doi: 10.1016/0035-9203(92)90114-r.
Records of 87 victims of rattlesnake bite who were admitted to a teaching in south-eastern Brazil from 1984 to 1990 were retrospectively examined. The patients came from 27 municipalities in 3 states. Most of the bites (47%) occurred between 10.00 h and 18.00 h and in April (13%). Identification of the snake was possible in only 17% of the cases, diagnosis being made on clinical grounds in the others. The lower limbs were the most common site of bite (85%). The median time interval between bite and receiving medical help was 3 h. Fang marks were observed in 47% of the cases, neurotoxic facies in 61%, and myalgia in 29%. Dark urine was reported in 40% of the cases. Clotting time was above 15 min in 53% of the tested cases. Use of a tourniquet before admission to hospital was reported 11 times. The mean dose of specific antivenom was 190 +/- 95.69 mg. The case fatality rate was 1%; 13 cases (18%) developed renal failure, 10 of whom needed dialysis. The chi 2 test for trend showed that both increased age and increased time interval between bite and medical help significantly increased the risk of renal failure (P < 0.02). Myalgia and neurotoxic facies were predictive of renal failure in patients older than 40 years (Fisher's exact test, P < 0.002 and P < 0.02, respectively). There was no significant association between dark urine or prolonged clotting time and renal failure.
对1984年至1990年期间入住巴西东南部一家教学医院的87名响尾蛇咬伤受害者的记录进行了回顾性检查。这些患者来自3个州的27个市。大多数咬伤（47%）发生在10:00至18:00之间，且4月份咬伤发生率最高（13%）。仅17%的病例能够识别蛇的种类，其他病例则根据临床症状进行诊断。下肢是最常见的咬伤部位（85%）。咬伤与接受医疗救助之间的中位时间间隔为3小时。47%的病例观察到牙痕，61%有神经毒性面容，29%有肌痛。40%的病例报告有深色尿液。53%的受测病例凝血时间超过15分钟。有11例报告在入院前使用了止血带。特异性抗蛇毒血清的平均剂量为190±95.69毫克。病死率为1%；13例（18%）发生肾衰竭，其中10例需要透析。趋势卡方检验表明，年龄增长以及咬伤与医疗救助之间的时间间隔增加均显著增加肾衰竭风险（P<0.02）。对于40岁以上患者，肌痛和神经毒性面容可预测肾衰竭（分别为费舍尔精确检验，P<0.002和P<0.02）。深色尿液或凝血时间延长与肾衰竭之间无显著关联。
