Gantait Kripasindhu, Patra Shinjan, Chowdhury Rajdip, Pramanick Subhroprakash
Department of General Medicine, Midnapore Medical College, Midnapore, West Bengal, India.
Natl Med J India. 2019 Jan-Feb;32(1):13-16. doi: 10.4103/0970-258X.272108.
Viper snake bite is a threat to the Indian health system with 83 000 deaths annually. There is a paucity of literature regarding independent risk factors for renal damage due to viper bite. We present the scenario in a rural part of West Bengal and highlight some vital factors to prevent the complications.
We screened all patients with snake bite from January 2012 to December 2015 in Midnapore Medical College and chose definite viper bites according to our inclusion criteria, treated them as per the Indian government protocol, followed them for any acute kidney injury, managed them with haemodialysis (HD) if needed and compared some socioeconomic and clinical factors between HD and non-HD groups to predict the outcome.
A total of 1220 snake bites were screened, 660 were viper bites, and 1 80 needed HD at least once. The HD group mostly consists of tribal population (75% v. 45% in non-HD group) who used unscientific first-aid measures. Bite timing was characteristically between 4 a.m. and 8 a.m., especially during defecation in fields, without any considerable seasonal variation. The average bite-to-needle time was 24.6 hours in the HD group and 5.1 hours in the non-HD group, with the average economic burden of ₹3345 in the HD group and ₹730 in the non-HD group.
Along with formal education, there is a need to create awareness among the relatively poor tribal population about snake bite to reduce the bite-to-needle time.
蝰蛇咬伤对印度卫生系统构成威胁,每年导致83000人死亡。关于蝰蛇咬伤导致肾损伤的独立危险因素的文献较少。我们介绍了西孟加拉邦农村地区的情况,并强调了一些预防并发症的关键因素。
我们在2012年1月至2015年12月期间对米德纳布尔医学院所有蛇咬伤患者进行了筛查,根据纳入标准选择确诊的蝰蛇咬伤患者,按照印度政府的方案进行治疗,随访观察是否发生急性肾损伤,必要时进行血液透析(HD)治疗,并比较HD组和非HD组的一些社会经济和临床因素以预测预后。
共筛查了1220例蛇咬伤患者,其中660例为蝰蛇咬伤,180例至少需要进行一次HD治疗。HD组主要为部落人口(75%,非HD组为45%),他们采用不科学的急救措施。咬伤时间主要在凌晨4点至8点之间,尤其是在田间排便时,且无明显季节性差异。HD组从咬伤到开始治疗的平均时间为24.6小时,非HD组为5.1小时,HD组的平均经济负担为3345卢比,非HD组为730卢比。
除了正规教育外,还需要提高相对贫困的部落人口对蛇咬伤的认识,以缩短咬伤到治疗的时间。