Bandyopadhyay Sanjay K, Ghosh Soumitra, Bandyopadhyay Ranjana, Dutta Anita
Department of Medicine, Nil Ratan Sircar Medical College, Kolkata 700014.
J Indian Med Assoc. 2009 Jan;107(1):12-3.
To identify the predictors of severe outcomes in patients with haemotoxic viper bite certain independent variables were recorded like age, sex, ethnicity, bite sites, duration of prehospital period, prehospital treatment, onset of systemic bleeding, local oedema, ecchymoses, blister, hematocrit, platelet count, whole blood clotting time, serum electrolytes, renal function and urinary examination findings in 62 hoptalised patients. Forward stepwise logistic regression was used for analysis of the independent factors predicting outcomes. Systemic bleeding was the commonest complication (45%). On multivariate analysis, alteration in coagulation parameters (like thrombocytopenia and prolonged whole blood clotting time) predisposed to systemic bleeding while local factors like bite site, faulty tourniquet application, and herbal treatment were responsible for local complications. Factors like massive envenomation and delayed hospitalisation significantly contributed to major organ damage. Predictors of death were anuria and systemic bleeding. It is concluded that several epidemiological, clinical, and laboratory features predict adverse outcomes in haemotoxic viper bite.
为了确定血循毒蝰蛇咬伤患者严重后果的预测因素，记录了某些自变量，如年龄、性别、种族、咬伤部位、院前时间、院前治疗、全身出血的发生、局部水肿、瘀斑、水疱、血细胞比容、血小板计数、全血凝固时间、血清电解质、肾功能及尿液检查结果，共纳入62例住院患者。采用向前逐步逻辑回归分析预测结局的独立因素。全身出血是最常见的并发症（45%）。多因素分析显示，凝血参数改变（如血小板减少和全血凝固时间延长）易导致全身出血，而咬伤部位、止血带应用不当和草药治疗等局部因素则是局部并发症的原因。大量蛇毒注入和延迟住院等因素显著导致主要器官损害。死亡的预测因素是无尿和全身出血。结论是，一些流行病学、临床和实验室特征可预测血循毒蝰蛇咬伤的不良结局。
