1Department of Intensive Care Unit, Academic Hospital Paramaribo, Paramaribo, Suriname.
2Academic Pediatric Center Suriname, Academic Hospital Paramaribo, Paramaribo, Suriname.
Am J Trop Med Hyg. 2020 Oct;103(4):1711-1716. doi: 10.4269/ajtmh.20-0144.
Venomous snakebites regularly occur in Suriname, a middle-income country located on the north coast of South America. Officially reported data on incidence and mortality are lacking. The aim of this retrospective study was to assess whether the use of our national snakebite protocol with selective administration of anti-snake venom (ASV) in patients with signs of snakebite envenoming improved clinical outcome as measured by mortality and length of stay (LOS) in the hospital. Medical records of all patients admitted at the Academic Hospital Paramaribo from 2013 to 2015, before and after the introduction of the protocol, with signs of snakebite envenoming, were reviewed for demographics, snakebite characteristics, mortality, length of hospital stay, administration of ASV, and occurrence of complications. Secondary outcome measures were the development of late complications due to a snakebite. Sixty-eight and 76 patients in 2013 and 2015, respectively, with venomous or potentially venomous snakebites were identified. One patient (1.5%) in 2013 and 29 patients (38.2%) in 2015 received ASV. In 2013 one patient died: deterioration of renal function occurred before protocolled ASV administration. No deaths were reported in 2015. There was no difference in the overall length of hospital stay between 2013 and 2015 or in the total number of late complications. In 2015, the mean LOS (±SD) for patients who did not receive ASV ( = 47) was significantly lower than that for patients who received ASV ( = 29), 2.15 ± 2.27 versus 5.31 ± 5.53 days, respectively ( = 0.001). The mean LOS (±SD) for patients who did not receive ASV in 2013 ( = 67) and 2015 ( = 47) was 4.06 ± 5.44 and 2.15 ± 2.27 days, respectively, which also differed significantly ( = 0.025). The protocolled evaluation of snakebite victims resulted in more patients being admitted to the intensive care unit and receiving ASV and a shorter length of hospital stay for the patients who did not receive ASV, and no difference in the occurrence of complications was observed in Suriname's largest hospital responsible for the acute care of snakebite victims.
苏里南是一个中低收入国家，位于南美洲北海岸，经常发生毒蛇咬伤事件。官方缺乏发病率和死亡率的报告数据。本回顾性研究的目的是评估在出现蛇咬伤中毒迹象的患者中使用我们的国家蛇咬伤协议并选择性使用抗蛇毒血清（ASV）是否可以改善临床结果，以死亡率和住院时间（LOS）为衡量标准。 对 2013 年至 2015 年期间在学术医院帕拉马里博入院的所有出现蛇咬伤中毒迹象的患者的病历进行了回顾，以评估人口统计学、蛇咬伤特征、死亡率、住院时间、ASV 的使用以及并发症的发生情况。次要结果测量指标是由于蛇咬伤而发生的晚期并发症。 2013 年和 2015 年分别有 68 名和 76 名有剧毒或潜在剧毒蛇咬伤的患者。2013 年有 1 名患者（1.5%）和 2015 年有 29 名患者（38.2%）接受了 ASV。2013 年有 1 名患者死亡：肾功能恶化发生在协议规定的 ASV 给药之前。2015 年无死亡报告。2013 年和 2015 年的总住院时间或总晚期并发症数量没有差异。2015 年，未接受 ASV 治疗的患者的平均 LOS（±SD）（= 47）明显低于接受 ASV 治疗的患者（= 29），分别为 2.15 ± 2.27 天和 5.31 ± 5.53 天（= 0.001）。2013 年（= 67）和 2015 年（= 47）未接受 ASV 治疗的患者的平均 LOS（±SD）分别为 4.06 ± 5.44 天和 2.15 ± 2.27 天，差异也有统计学意义（= 0.025）。对蛇咬伤受害者进行协议评估导致更多患者入住重症监护病房并接受 ASV 治疗，未接受 ASV 治疗的患者住院时间缩短，但在负责急性蛇咬伤治疗的苏里南最大医院中，并未观察到并发症发生率的差异。
