Sotelo-Cruz Norberto, Gómez-Rivera Norberto
Department of Medicine and Health Sciences, University of Sonora, Children's Hospital of the State of Sonora (HIES), Hermosillo, Sonora, Mexico -
Emergency Service, Children's' Hospital of the State of Sonora (HIES), Hermosillo, Sonora, Mexico.
Minerva Pediatr. 2017 Apr;69(2):121-128. doi: 10.23736/S0026-4946.16.04226-2.
A retrospective review of clinical features and treatment of children hospitalized for rattlesnake bite.
One hundred clinical records were reviewed. Variables included: age, gender, season of the year, signs, symptoms, poisoning grade, complications, treatment and sequelae.
Fifty-nine percent were males and 37% were less than 5 years of age; 87% occurred in rural areas; 63% of the snakebites occurred during the summer, of them, 39% occurred within the perimeter of the domicile and 8% within the home. Sixty-seven percent of children bitten by snakes reached the second degree of envenomation. During the first period (1977-1996), treatment for intoxication included treatment with polyvalent equine anti-snake venom serum. During the second period (1997-2014, a polyvalent polyclonal horse anti-snake venom F(Ab) was used. The second period hospitalization time was reduced to 3.9 days (P<0.0001). Hematological complications dominated during the first period (P=0.093) with wound infections occurring in 26% of the cases, neurological symptoms in 24 %, fasciotomy in 6% and mortality in 1%. The second degree poisoning was more frequent and was more severe in 7% of the patients. It was determined that the best treatment for snakebite was F(Ab') 2 therapy. Mortality occurred in 1% of the cases.
Rattlesnake (Crotalus sp.) bite, in Mexico is less frequent as compared to other crotalidae species. The hematological complications are more frequent. We did not observe any recurrent phenomenons.
对因被响尾蛇咬伤而住院的儿童的临床特征及治疗进行回顾性研究。
回顾了100份临床记录。变量包括：年龄、性别、年份季节、体征、症状、中毒等级、并发症、治疗及后遗症。
59%为男性，37%年龄小于5岁；87%发生在农村地区；63%的蛇咬伤发生在夏季，其中39%发生在住所周边，8%发生在屋内。67%被蛇咬伤的儿童达到二级中毒。在第一阶段（1977 - 1996年），中毒治疗包括使用多价马抗蛇毒血清。在第二阶段（1997 - 2014年），使用多价多克隆马抗蛇毒F(Ab)。第二阶段住院时间缩短至3.9天（P<0.0001）。第一阶段血液学并发症占主导（P = 0.093），26%的病例发生伤口感染，24%出现神经症状，6%进行筋膜切开术，1%死亡。二级中毒更常见，7%的患者病情更严重。确定蛇咬伤的最佳治疗方法是F(Ab')2疗法。1%的病例发生死亡。
在墨西哥，与其他蝰蛇科物种相比，响尾蛇（响尾蛇属）咬伤较少见。血液学并发症更常见。我们未观察到任何复发现象。
