Ogunfowokan O, Jacob D A, Livinus O L
Department of Family Medicine, National Hospital, Abuja, Nigeria.
West Afr J Med. 2011 Sep-Oct;30(5):348-53.
Envenomation from snake bites is a public health hazard in tropical countries. The observed mortality among in-hospital patients bitten by carpet viper (Echis ocellatus) in northern Nigeria has drastically reduced, related to the use of a mono-specific ovine Fab anti-snake venom. However, many victims survive with temporary or permanent physical or psychological sequelae.
Our aim was to find the relationship between bite-to-hospital time and morbidity in patients bitten by carpet viper.
A prospective study was conducted in North-Central Nigeria. The signs of morbidity scored were oedema, tenderness, prolonged whole blood clotting time, blister, ulcer, need for blood transfusion, coma, hypotension, convulsion, length of hospital stay, need for disarticulation, and need for skin graft. A score of 1 was given to each objective and verifiable sign. Bite-to-hospital time of 233 subjects was obtained.
Most of the subjects, 150(64%) came to the hospital within six hours of snake bite, out of whom two(1%) came within one hour. The median bite-to-hospital time was five hours with a range of 0.5-216 hours. Major morbidities were oedema accounting for 212 (91.0%; 95% CI =86.6-94.3%). incoagulable blood was seen in 205(88%; 95% CI = 83.1-91.9%) and tenderness in 201(86.3%; 95% CI = 81.2-90.4%). The mean morbidity score was 8 ± 4. For every unit increase in log bite-to-hospital time, the morbidity score increased by 1.85 (p < 0.001).
Morbidity caused by carpet viper bite is high in Nigeria and worsens with increasing bite-to-hospital time.
蛇咬伤中毒是热带国家的一项公共卫生危害。在尼日利亚北部，因被地毯蝰蛇（锯鳞蝰）咬伤而住院的患者中，观察到的死亡率已大幅降低，这与使用单特异性羊源Fab抗蛇毒血清有关。然而，许多受害者虽存活下来，但伴有暂时或永久性的身体或心理后遗症。
我们的目的是找出被地毯蝰蛇咬伤的患者的咬伤至入院时间与发病率之间的关系。
在尼日利亚中北部进行了一项前瞻性研究。对发病率进行评分的体征包括水肿、压痛、全血凝固时间延长、水泡、溃疡、输血需求、昏迷、低血压、惊厥、住院时间、截肢需求和植皮需求。每个客观且可核实的体征给予1分。获取了233名受试者的咬伤至入院时间。
大多数受试者，即150名（64%）在蛇咬伤后6小时内入院，其中2名（1%）在1小时内入院。咬伤至入院时间的中位数为5小时，范围为0.5 - 216小时。主要发病率为水肿，占212例（91.0%；95%置信区间 = 86.6 - 94.3%）。205例（88%；95%置信区间 = 83.1 - 91.9%）出现血液无法凝固，201例（86.3%；95%置信区间 = 81.2 - 90.4%）出现压痛。平均发病率评分为8 ± 4。每单位对数咬伤至入院时间增加，发病率评分增加1.85（p < 0.001）。
在尼日利亚，地毯蝰蛇咬伤导致的发病率很高，且随着咬伤至入院时间的增加而恶化。
