Hospital Vital Brazil, Instituto Butantan, Av. Vital Brazil 1500, 05503-900, São Paulo, SP, Brazil.
Toxicon. 2010 Nov;56(6):1018-24. doi: 10.1016/j.toxicon.2010.07.006. Epub 2010 Jul 17.
We retrospectively analyzed 297 proven cases of Philodryas patagoniensis bites admitted to Hospital Vital Brazil (HVB), Butantan Institute, São Paulo, Brazil, between 1959 and 2008. Only cases in which the causative animal was brought and identified were included. Part of the snakes brought by the patients was still preserved in the collection maintained by the Laboratory of Herpetology. Of the 297 cases, in 199 it was possible to describe the gender of the snake, and seventy three (61.3%) of them were female. The length of snakes (snout-vent length) ranged from 160 to 1080 mm. In 117 snakes their state of preservation enabled the dissection and examination of their stomach contents. The stomach was empty in 106 snakes (89.1%). Most bites occurred in the seasons of spring and summer (n = 196, 66.0%) and during warmer periods of the day. The mean age of the victims was 24.1 +/- 15.1 years old and 206 (69.4%) patients were men. Around 92% of the patients sought medical care within 6 h after the bite. Both lower (n = 188, 63.3%) and upper limbs (n = 102, 34.3%) were most frequently bitten, especially the feet and hands (n = 205, 69.0%). The local clinical manifestations were pain (n = 151, 50.8%), transitory bleeding (n = 106, 35.7%), erythema (n = 47, 15.8%) and edema (n = 39, 13.1%). Ecchymosis was not observed. Only 7 (2.4%) patients reported systemic symptoms characterized by mild dizziness and 88 patients (29.6%) showed no evidence of envenoming. The whole blood clotting time was performed in 76 (25.6%) patients on admission and all of them had coagulable blood. Supportive treatment was offered to only 13.4% of patients, namely administration of antihistamines (n = 19, 6.4%) and analgesics (n = 12, 4.1%). Eight patients (2.7%) were mistreated with Bothrops antivenom before their admission to HVB. No sequels or relevant complications were observed in patients, and the prognostic was benign. Therefore, although P. patagoniensis accidents can cause mild local symptomatology, it is very important that health professionals know how to make the correct diagnosis to avoid unnecessary use of antivenom.
我们回顾性分析了 1959 年至 2008 年期间巴西圣保罗布坦坦研究所巴西生命医院（HVB）收治的 297 例 Philodryas patagoniensis 咬伤的确诊病例。只有那些携带并确认了致病动物的病例才被纳入研究。部分患者带来的蛇仍保存在实验室的爬虫学收藏中。在 297 例病例中，有 199 例能够描述蛇的性别，其中 73 例（61.3%）为雌性。蛇的长度（吻肛长度）从 160 毫米到 1080 毫米不等。在 117 条蛇中，其保存状态允许对其胃内容物进行解剖和检查。106 条蛇（89.1%）的胃是空的。大多数咬伤发生在春季和夏季（n=196，66.0%）和白天较温暖的时期。受害者的平均年龄为 24.1+/-15.1 岁，其中 206 名（69.4%）为男性。约 92%的患者在咬伤后 6 小时内寻求医疗救助。上下肢（n=188，63.3%）和上肢（n=102，34.3%）均为最常咬伤的部位，尤其是脚部和手部（n=205，69.0%）。局部临床表现为疼痛（n=151，50.8%）、短暂性出血（n=106，35.7%）、红斑（n=47，15.8%）和水肿（n=39，13.1%）。未见瘀斑。仅有 7 名（2.4%）患者报告有轻度头晕等全身症状，88 名（29.6%）患者无中毒证据。入院时对 76 名（25.6%）患者进行了全血凝固时间检查，所有患者的血液均可凝固。仅 13.4%的患者接受了支持性治疗，即给予抗组胺药（n=19，6.4%）和镇痛药（n=12，4.1%）。在被送往 HVB 之前，有 8 名（2.7%）患者接受了 Bothrops 抗蛇毒血清的不当治疗。患者无后遗症或相关并发症，预后良好。因此，尽管 P. patagoniensis 事故可能导致轻度局部症状，但卫生专业人员了解如何做出正确诊断非常重要，以避免不必要地使用抗蛇毒血清。
