Longkumer Takanungsang, Armstrong Lois J, Finny Philip
Duncan Hospital, A Unit of Emmanuel Hospital Association, Raxaul, East Champaran District, Bihar, India.
J Venom Res. 2017 Jun 28;8:14-18. eCollection 2017.
Bihar is the state with the third largest number of snakebite deaths per year in India. This prospective, one-year study of 608 snakebites provides the first data from Bihar on determinants of unfavourable outcomes in snakebites. Any delay in reaching hospital raised the risk of a snakebite patient for an unfavourable outcome [OR 8.88, CI 2.04-38.8]. Attending a traditional practitioner prior to presenting to the hospital was the only specific, significant delay [OR 3.52, CI 1.26-9.7]. Prevention of unfavourable outcomes occurred by presenting to hospital in less than 1.5 hours [OR 0.23, CI 0.052-1.0]. Motorbike was the best mode of transport [OR 0.37, CI 0.12-1.1]. Other risk factors were patients aged under 15 years [OR 3.79, CI 1.57-9.12] and bites to the upper limb [OR 2.47, CI 1.01-6.04]. Patients who were envenomated had a higher risk of unfavourable outcome, if referred due to antivenom being unavailable [OR 12.2, CI 1.49-100]. To save lives, it is imperative that measures to reduce delays in getting patients to hospital must be included in snakebite management, alongside continued availability of antivenom and assisted ventilation.
比哈尔邦是印度每年蛇咬伤致死人数第三多的邦。这项针对608例蛇咬伤病例的前瞻性为期一年的研究提供了比哈尔邦关于蛇咬伤不良结局决定因素的首批数据。到达医院的任何延迟都会增加蛇咬伤患者出现不良结局的风险[比值比8.88，可信区间2.04 - 38.8]。在前往医院之前寻求传统治疗师的帮助是唯一特定的、显著的延迟因素[比值比3.52，可信区间1.26 - 9.7]。在不到1.5小时内前往医院可预防不良结局的发生[比值比0.23，可信区间0.052 - 1.0]。摩托车是最佳的交通工具[比值比0.37，可信区间0.12 - 1.1]。其他风险因素包括15岁以下的患者[比值比3.79，可信区间1.57 - 9.12]以及上肢被咬伤[比值比2.47，可信区间1.01 - 6.04]。如果因抗蛇毒血清不可用而转诊，被注入毒液的患者出现不良结局的风险更高[比值比12.2，可信区间1.49 - 100]。为了挽救生命，在蛇咬伤治疗中，必须采取措施减少患者前往医院的延迟，同时持续提供抗蛇毒血清和辅助通气。
