Kochar D K, Tanwar P D, Norris Robert L, Sabir M, Nayak K C, Agrawal T D, Purohit V P, Kochar A, Simpson Ian D
S.P. Medical College Bikaner, Rajasthan, India
Wilderness Environ Med. 2007 Summer;18(2):75-85. doi: 10.1580/06-WEME-OR-078R.1.
In India, venomous snakebite remains an enigma. Although ineffective first aid treatments that are centuries old continue to be used by people bitten by snakes, important factual information, such as the importance and uniqueness of bites by the northern saw-scaled viper (Echis sochureki), has been largely lost and forgotten. In this paper, we report the first systematically gathered data on the clinical course of envenoming by E sochureki in Rajasthan, India. Clinical information is reported on 12 victims bitten by definitively identified E sochureki, and 2 clinical cases are described in greater detail to illustrate the severity of envenoming by this snake.
A data collection form was developed and used to prospectively gather clinical information regarding patients who were bitten by E sochureki and who brought the dead snake with them to hospital. All snakes were definitively identified by an experienced herpetologist. Information on symptoms and signs, management (both first aid and hospital), and outcomes was collected.
All 12 victims had evidence of systemic envenoming, including abnormal 20-minute whole blood clotting tests (with systemic bleeding in 7). All received polyvalent antivenom made, in part, with Echis carinatus venom from southern India. Antivenom was relatively ineffective in restoring coagulation to these patients. All patients survived, although 1 patient suffered an intracranial bleed with residual hemiparesis.
Echis sochureki causes severe bites in Rajasthan. Work needs to be done to alter the first aid practices used for snakebites in this area, to encourage more rapid presentation to hospital, and to develop antivenom that is more effective against E sochureki.
在印度，毒蛇咬伤仍是一个谜。尽管被蛇咬的人仍在使用已有数百年历史但无效的急救方法，但一些重要的事实信息，如印度锯鳞蝰（Echis sochureki）咬伤的重要性和独特性，已基本被遗忘。在本文中，我们报告了印度拉贾斯坦邦关于印度锯鳞蝰致伤临床过程的首批系统收集的数据。报告了12例被明确鉴定为印度锯鳞蝰咬伤的受害者的临床信息，并详细描述了2例临床病例以说明这种蛇致伤的严重程度。
设计了一份数据收集表，用于前瞻性收集被印度锯鳞蝰咬伤并将死蛇带到医院的患者的临床信息。所有蛇均由经验丰富的爬虫学家明确鉴定。收集了有关症状和体征、治疗（包括急救和住院治疗）及结果的信息。
所有12名受害者均有全身中毒的证据，包括20分钟全血凝血试验异常（7例有全身出血）。所有患者均接受了部分由来自印度南部的锯鳞蝰毒液制成的多价抗蛇毒血清治疗。抗蛇毒血清在恢复这些患者的凝血功能方面相对无效。所有患者均存活，尽管1例患者发生颅内出血并遗留偏瘫。
印度锯鳞蝰在拉贾斯坦邦可造成严重咬伤。需要开展工作以改变该地区用于蛇咬伤的急救方法，鼓励患者更快地前往医院就诊，并研发对印度锯鳞蝰更有效的抗蛇毒血清。
