Ghosh Soumitra, Maisnam Indira, Murmu Bijoy K, Mitra Pradip K, Roy Aniruddha, Simpson Ian D
Midnapore Medical College, West Bengal, Inda.
Wilderness Environ Med. 2008 Winter;19(4):267-74. doi: 10.1580/08-WEME-OR-219.1.
The purpose of this study was to determine the impact of a nationally developed snakebite treatment protocol on the amount of anti snake venom (ASV) used in treating snakebites in a developing country and its effect on mortality. In addition, basic epidemiology data were collected and analyzed.
Experts in Indian snakebites developed a protocol specifically designed for snakebite treatment in India. A training program was implemented in Midnapore Medical College in West Bengal, India, under the direction of the Health Minister to train care providers in the new protocol. After training, data were collected for 839 snakebite victims over a 12-month period and included epidemiological data, ASV volumes administered, and mortality. The results were collated and compared with results calculated from 780 snakebite victims treated during the 12-month period before implementation of the protocol. Treatment prior to protocol implementation was based on knowledge gained by the care providers from western and forensic medicine textbooks.
Protocol-guided treatment resulted in a 66% decline in the amount of ASV administered to victims. Fewer victims received ASV based on rational guidelines for assessing envenomation, dosage and repeat dosage, and clear endpoints to ASV therapy. In addition, there was a trend towards reduced mortality and an absolute reduction of 24%.
Use of the protocol reduced ASV utilization and the number of deaths. Locally developed protocols should be encouraged by such organizations as the World Health Organization and national and state governments and should be established with significant input from local experts.
本研究旨在确定一项全国制定的蛇咬伤治疗方案对一个发展中国家治疗蛇咬伤时抗蛇毒血清（ASV）使用量的影响及其对死亡率的影响。此外，还收集并分析了基本的流行病学数据。
印度蛇咬伤专家制定了一项专门为印度蛇咬伤治疗设计的方案。在印度卫生部长的指导下，在西孟加拉邦的米德纳波尔医学院实施了一项培训计划，以培训护理人员掌握新方案。培训后，在12个月内收集了839名蛇咬伤受害者的数据，包括流行病学数据、ASV使用量和死亡率。对结果进行整理，并与方案实施前12个月内治疗的780名蛇咬伤受害者计算得出的结果进行比较。方案实施前的治疗基于护理人员从西医和法医学教科书中获得的知识。
方案指导下的治疗使给予受害者的ASV量下降了66%。根据评估中毒、剂量和重复剂量的合理指南以及ASV治疗的明确终点，接受ASV的受害者减少。此外，有死亡率降低的趋势，绝对降低了24%。
该方案的使用减少了ASV的使用和死亡人数。世界卫生组织以及国家和州政府等组织应鼓励使用当地制定的方案，并且应在当地专家的大量参与下制定这些方案。
