罗素蝰蛇和锯鳞蝰蛇咬伤中毒的诊断：印度马哈拉施特拉邦农村地区的一项临床研究
Diagnosis of envenomation by Russell's and Echis carinatus viper: A clinical study at rural Maharashtra state of India.
作者信息
Bawaskar Himmatrao S, Bawaskar Pramodini H
机构信息
Department of Clinical Medicine, Bawaskar Hospital and Clinical Research Center, Mahad, Raigad, Maharashtra, India.
出版信息
J Family Med Prim Care. 2019 Apr;8(4):1386-1390. doi: 10.4103/jfmpc.jfmpc_156_19.
BACKGROUND
Envenoming by vipers and are common accidents faced by farmers and labors. Both viper venom toxins alter coagulation mechanism in the victim. The dose of snake antivenin to neutralize the venom is empirical and varies. Though the clinical manifestations in both vipers bite envenoming are nearly similar but dose of antivenin required is more in . We studied in detail about the correlation of clinical manifestations and confirmed species of snake.
METHODS
Cases of vipers snake bites admitted for last two successive years were studied. Analysis by local manifestations, systemic involvement, 20 minute whole blood clotting test (20WBCT), identification of snake responsible for clinical effects are confirmed by the snake species brought by victims or bystanders, in case of where victim saw the snake bur failed to kill. The victims identified from pictures of big four poisonous snakes (, , Cobra, and krait). Further confirmation from the species responsible is done by showing the hospital preserved specimen to identify the culprits.
FINDINGS
About 77 cases of viper bite studied of these 57 has clinical syndrome suggestive of (RV) bite, one has dry bite, 23 victims brought the killed specimen confirmed RV, of these 18 identified the specimen picture and 5 wrongly locate the species in pictures, 20 victims correctly identified the hospital preserved specimen while 3 failed to recognize. There were 28 patients who saw the snake while bitten but failed to kill, of these 20 patients identify correctly the species on picture while 8 failed to identify. Only 22 correctly identified the culprit by looking at the hospital preserved specimen and 6 were confused. One dry bite victim correctly identified the bitten snake species in picture and hospital preserved specimen.
INTERPRETATION
In viper bite poisoning clinical pictures and hospital specimen help to confirm the species are highly supportive for clinical diagnosis.
背景
蝰蛇咬伤是农民和劳动者常见的意外事故。两种蝰蛇毒液毒素都会改变受害者的凝血机制。用于中和毒液的蛇抗毒素剂量是经验性的且各不相同。尽管两种蝰蛇咬伤中毒的临床表现几乎相似，但 所需的抗毒素剂量更多。我们详细研究了临床表现与确诊蛇种之间的相关性。
方法
对连续两年收治的蝰蛇咬伤病例进行研究。通过局部表现、全身受累情况、20分钟全血凝血试验（20WBCT）进行分析，若受害者看到蛇但未将其打死，由受害者或旁观者带来的蛇来确认导致临床症状的蛇种；通过四大毒蛇（ 、 、眼镜蛇和金环蛇）的图片来识别受害者。通过展示医院保存的标本以确定罪魁祸首，进一步确认相关蛇种。
研究结果
在研究的约77例蝰蛇咬伤病例中，57例有提示 （RV）咬伤的临床综合征，1例为干咬，23名受害者带来了已打死的标本，经确认是RV，其中18例识别出标本图片，5例在图片中错误定位了蛇种，20名受害者正确识别了医院保存的标本，3例未识别出来。有28名患者在被咬时看到了蛇但未将其打死，其中20例患者在图片上正确识别了蛇种，8例未识别出来。只有22例通过查看医院保存的标本正确识别了罪魁祸首，6例混淆不清。1例干咬受害者在图片和医院保存的标本中正确识别了被咬蛇种。
解读
在蝰蛇咬伤中毒中，临床症状和医院标本有助于确认蛇种，对临床诊断有很大帮助。
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