儿童蛇伤中毒：哥斯达黎加儿科三级护理中心的被忽视热带病。
Snakebite envenoming in children: A neglected tropical disease in a Costa Rican pediatric tertiary care center.
机构信息
Pediatric Infectious Diseases Division, Pediatric Hemato-Oncology Division, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica.
Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica.
出版信息
Acta Trop. 2019 Dec;200:105176. doi: 10.1016/j.actatropica.2019.105176. Epub 2019 Sep 14.
BACKGROUND
Introduced in June 2017 by the World Health Organization (WHO) as a Neglected Tropical Diseases, snakebite envenoming is a global health problem. In Costa Rica, an incidence of 15 per 100,000 inhabitants and a mortality rate of 0.15 per 100,000 inhabitants per year were reported from 2005-2012. Children are also affected and prone to complications.
METHODS
Retrospective descriptive 14-year study of children with envenomings by Viperidae snakebites managed at the tertiary pediatric hospital in Costa Rica.
FINDINGS
80 patients (pts) were included and classified as having mild (17 pts, 29.3%), moderate (58 pts, 72.5%) or severe (5 pts, 6.2%) envenoming. 52/80 (65%) patients received treatment within the first four hours, three (3.75%) between 5-8 h, three between 9-12 h, four (4%) between 13-16 h, two (2.5%) between 17-20 h, and seven (8.75%) after 20 h. Edema was documented in 76/80 (95%), pain in 58 (72.5%), local bleeding in 23 (28.8%), emesis in 10 (12.5%), bullae formation in 8 (10%), and tissue necrosis in three (3.8%) pts. Complications presented according with degree of envenoming, being more common in severe cases: wound infection occurred in 14/58 (24.1%) with moderate envenoming and 5/5 pts with severe envenoming (p < 0.0001), bleeding presented in 3/58 (5.2%) with moderate cases, and 2/5 (40%) in pts with severe envenoming (p = 0.004); and compartmental syndrome occurred in 3/17 (17.6%) pts with mild envenoming, in 33/58 (56.9%), and 5/5 of moderate and severe envenomed pts, respectively (p = 0.0014). Sequelae were documented 25/80 (31%).
背景
2017 年 6 月，世界卫生组织（WHO）将蛇咬伤纳入被忽视的热带病范畴，蛇咬伤已成为全球性健康问题。2005 年至 2012 年，哥斯达黎加报告的发病率为每 10 万人中有 15 例，死亡率为每年每 10 万人中有 0.15 例。儿童也会受到影响，并容易出现并发症。
方法
对哥斯达黎加一家三级儿科医院收治的 80 例 Viperidae 蛇咬伤儿童患者进行回顾性描述性 14 年研究。
结果
80 例患者中，轻度（17 例，29.3%）、中度（58 例，72.5%）和重度（5 例，6.2%）咬伤患者分别为 52/80（65%）例患者在伤后 4 小时内接受治疗，3 例（3.75%）在 5-8 小时内，3 例在 9-12 小时内，4 例（4%）在 13-16 小时内，2 例（2.5%）在 17-20 小时内，7 例（8.75%）在 20 小时后接受治疗。80 例患者中，76 例（95%）出现肿胀，58 例（72.5%）出现疼痛，23 例（28.8%）出现局部出血，10 例（12.5%）出现呕吐，8 例（10%）出现水疱，3 例（3.8%）出现组织坏死。并发症的出现与蛇伤的严重程度有关，严重者更为常见：58 例中度咬伤患者中有 14 例（24.1%）出现伤口感染，5 例重度咬伤患者均出现伤口感染（p<0.0001），33 例（56.9%）中度咬伤患者出现出血，2 例（40%）重度咬伤患者出现出血（p=0.004），17 例（17.6%）轻度咬伤患者出现筋膜间室综合征，58 例（56.9%）和 5 例（100%）中度和重度咬伤患者出现筋膜间室综合征（p=0.0014）。80 例患者中，25 例（31%）有后遗症。
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