Suchithra N, Pappachan J M, Sujathan P
Department of Medicine, Kottayam Medical College, Kerala, South India 686008.
Emerg Med J. 2008 Apr;25(4):200-4. doi: 10.1136/emj.2007.051136.
Snakebite envenoming is an important medical emergency in Kerala, but the factors leading to complications have not been well studied.
To study the clinical characteristics, factors involved in complications and the outcomes in relation to timing of polyvalent snake antivenom (SAV) administration in patients with snakebite envenoming.
Patients were recruited from cases of snakebites admitted to the emergency care unit of Kottayam Medical College between May 2005 and December 2006. The manifestations of envenoming and complications were recorded. SAV was administered to cases with envenoming. Treated patients were analysed to determine the factors involved in complications and the outcomes in relation to the timing of SAV.
200 (34%) of 586 cases with snakebites had envenoming; 58% were men, 52% were aged 31-50 years and 93% were outdoor bites. The species of snake was identified in 34.5% of the venomous bites. 93.5% had signs of local envenoming. Regional lymphadenitis occurred in 61%. The mortality rate was 3%. Capillary leak syndrome, respiratory paralysis and intracerebral bleeding were the risk factors for mortality. Those who received SAV early (bite to needle time <6 h) had more severe local envenoming than those who received SAV late (bite to needle time >or =6 h), but the latter group were more likely to suffer complications. 39.5% had complications, with acute renal failure being the most common (25.5%). Those who received SAV late had a higher risk of developing acute renal failure. Higher rates of complications were seen in those with severe coagulopathy (OR = 8.0), leucocytosis (OR = 3.7) and those who received SAV late.
Early administration of SAV reduces the risk of complications. The presence of leucocytosis and severe coagulopathy can predict adverse outcomes.
蛇咬伤中毒是喀拉拉邦一项重要的医疗急症，但导致并发症的因素尚未得到充分研究。
研究蛇咬伤中毒患者的临床特征、并发症相关因素以及多价蛇抗毒血清（SAV）给药时间与预后的关系。
研究对象来自2005年5月至2006年12月在科塔亚姆医学院急诊室收治的蛇咬伤病例。记录中毒表现和并发症情况。对中毒病例给予SAV治疗。对接受治疗的患者进行分析，以确定并发症相关因素以及与SAV给药时间相关的预后情况。
586例蛇咬伤病例中有200例（34%）出现中毒；58%为男性，52%年龄在31 - 50岁之间，93%为户外咬伤。34.5%的毒蛇咬伤病例能确定蛇的种类。93.5%有局部中毒体征。61%发生区域性淋巴结炎。死亡率为3%。毛细血管渗漏综合征、呼吸麻痹和脑出血是死亡的危险因素。早期接受SAV治疗的患者（咬伤至注射时间<6小时）局部中毒比晚期接受SAV治疗的患者（咬伤至注射时间≥6小时）更严重，但后者更容易出现并发症。39.5%的患者出现并发症，其中急性肾衰竭最为常见（25.5%）。晚期接受SAV治疗的患者发生急性肾衰竭的风险更高。严重凝血功能障碍患者（比值比=8.0）、白细胞增多患者（比值比=3.7）以及晚期接受SAV治疗的患者并发症发生率更高。
早期给予SAV可降低并发症风险。白细胞增多和严重凝血功能障碍可预测不良预后。
