Sharma Rupinder, Dogra Varundeep, Sharma Gurudutt, Chauhan Vivek
Department of Medicine, Dr. RPGMC Tanda, Kangra, Himachal Pradesh, India.
Int J Crit Illn Inj Sci. 2016 Jul-Sep;6(3):115-118. doi: 10.4103/2229-5151.190652.
In North India snake bite deaths are predominantly seen with neurotoxic envenomations (NEs) whereas in South India the hemotoxic envenomation (HE) is more common. Krait is responsible for most deaths in North India. It bites people sleeping on the floors, mostly at night. We describe the profile of venomous snake bites over 1 year in 2013.
The study was conducted in a rural tertiary care hospital in North India. Demographics, circumstances of bite, envenomation, first aid, delay, consultation, treatment, anti-venom, and outcomes were recorded for all victims of snake bite. We included all consecutive adult (>18 years) venomous snake bite victims admitted from January to December 2013.
A total of 91 patients with venomous snake bites were included in the study. Pure NEs were 41 (45.1%), pure HE in 31 (34.1%), 7 (7.7%) had mixed NE + HE, and 12 (13.2%) had only local swelling. Forty patients (44%) were bitten during sleep presenting as NE (92.5%), NE + HE (5%), and HE (2.5%). Findings in the 51 patients (56%) bitten during activity were HE (58.8%), local swelling (23.5%), NE + HE (9.8%), and NE (7.8%) ( < 0.0001). First aid was sought by 24 NE patients out of which 23 (96%) went to alternate practitioners or religious healers.
Almost all (97.5%) bites during sleep resulted in NE in our study. About 96% of NE sought first aid from alternate practitioners or religious healers in hope of some magical treatment. Thus, a deadly combination of krait bite during sleep and wrong health seeking behavior is responsible for high mortality krait bites in this region. Mass public awareness regarding krait bites can prevent mortality in many such cases.
在印度北部，蛇咬伤致死主要见于神经毒性蛇伤（NEs），而在印度南部，血液毒性蛇伤（HE）更为常见。金环蛇是印度北部大多数死亡病例的罪魁祸首。它咬伤睡在地上的人，大多在夜间。我们描述了2013年1年期间毒蛇咬伤的情况。
该研究在印度北部一家农村三级护理医院进行。记录了所有蛇咬伤受害者的人口统计学信息、咬伤情况、蛇伤类型、急救措施、延误情况、会诊、治疗、抗蛇毒血清使用及预后。我们纳入了2013年1月至12月期间收治的所有连续成年（>18岁）毒蛇咬伤患者。
该研究共纳入91例毒蛇咬伤患者。单纯神经毒性蛇伤41例（45.1%），单纯血液毒性蛇伤31例（34.1%），7例（7.7%）为混合性神经毒性+血液毒性蛇伤，12例（13.2%）仅有局部肿胀。40例（44%）患者在睡眠中被咬伤，表现为神经毒性蛇伤（92.5%）、神经毒性+血液毒性蛇伤（5%）和血液毒性蛇伤（2.5%）。51例（56%）在活动时被咬伤的患者中，血液毒性蛇伤（58.8%）、局部肿胀（23.5%）、神经毒性+血液毒性蛇伤（9.8%）和神经毒性蛇伤（7.8%）（<0.0001）。24例神经毒性蛇伤患者寻求了急救，其中23例（96%）去找了其他从业者或宗教治疗师。
在我们的研究中，几乎所有（97.5%）睡眠期间的咬伤都导致了神经毒性蛇伤。约96%的神经毒性蛇伤患者向其他从业者或宗教治疗师寻求急救，希望得到某种神奇的治疗。因此，睡眠期间被金环蛇咬伤与错误的求医行为这一致命组合是该地区金环蛇咬伤死亡率高的原因。开展大规模公众金环蛇咬伤防治宣传可预防许多此类病例的死亡。
