Kumar Awanish, Dungdung Ajit, Kumar Abhinav, Kumar Ravi, Pandey Vikas, Priya Shimpy
Department of General Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
J Family Med Prim Care. 2022 Nov;11(11):7089-7094. doi: 10.4103/jfmpc.jfmpc_588_22. Epub 2022 Dec 16.
Snakebite is a common occupational hazard in tropical countries such as India. India has the highest number of snakebites and accounts for nearly 50% of global snakebite deaths. Jharkhand is a state with abundant flora and fauna, with a large rural population, prone to snakebite deaths. We aimed to study various clinical and laboratory parameters in snakebite patients and their association with mortality.
This study was an analytical cross-sectional study conducted from October 2019 to April 2021. Snake-bitten individuals admitted in the in-patient department (General Medicine) of a tertiary care centre of Jharkhand state were included in this study. Information regarding gender, species of the snake, site of bite, symptoms (neurological and haematological), signs, reaction to ASVS, procedures performed (haemodialysis), general examinations, systemic examinations, and investigations were collected and analysed to predict mortality.
Out of 60 snakebite patients, 39 (65%) were males and 21 (35%) were females. Snakebite in 41.67% patients was because of unknown species, snakebite in 26.67% patients was because of Russell's viper, snakebite in 21.67% was because of krait, and snakebite in 10% was because of cobra. 41.67% of individuals sustained bites over the right leg, 23.33% over the left leg, 18.33% over the right arm, and 15% over the left arm. Mortality was seen in 8 (13.33%) patients. Haemorrhagic manifestations including haematuria and haemoptysis were seen in 10 (16.66%) and 3 (5%) patients, respectively. Neurological symptoms were present in 27 (45%) patients. In laboratory examination, the total leucocyte count, international normalised ratio, d-dimer, urea, creatinine, and amylase were significantly high in the non-survivor group (all values < 0.05). In this study, mortality was significantly associated with increased requirement of haemodialysis because of renal failure and an increase in duration of hospital stay ( value < 0.05). The duration of hospital stay independently predicts mortality with an odds ratio of 0.514 (95% confidence interval 0.328 to 0.805; = 0.004).
Early evaluation of clinical and laboratory parameters is needed to identify various complications (haematological and neurological) as they may prolong the hospital stay, leading to an increase in mortality.
在印度等热带国家，蛇咬伤是一种常见的职业危害。印度蛇咬伤病例数量最多，占全球蛇咬伤死亡人数的近50%。恰尔肯德邦是一个动植物资源丰富的邦，农村人口众多，容易发生蛇咬伤致死事件。我们旨在研究蛇咬伤患者的各种临床和实验室参数及其与死亡率的关联。
本研究为2019年10月至2021年4月进行的分析性横断面研究。纳入恰尔肯德邦一家三级医疗中心内科（普通内科）收治的蛇咬伤患者。收集并分析有关性别、蛇的种类、咬伤部位、症状（神经和血液方面）、体征、抗蛇毒血清反应、所采取的治疗措施（血液透析）、一般检查、系统检查及各项检验结果等信息，以预测死亡率。
60例蛇咬伤患者中，男性39例（65%），女性21例（35%）。41.67%的患者蛇咬伤原因不明，26.67%的患者因罗素蝰蛇咬伤，21.67%因金环蛇咬伤，10%因眼镜蛇咬伤。41.67%的患者右腿被咬伤，23.33%左腿被咬伤，18.33%右臂被咬伤，15%左臂被咬伤。8例（13.33%）患者死亡。分别有10例（16.66%）和3例（5%）患者出现血尿和咯血等出血表现。27例（45%）患者有神经症状。实验室检查发现，非存活组的白细胞总数、国际标准化比值、D-二聚体、尿素、肌酐和淀粉酶显著升高（所有P值<0.05）。本研究中，死亡率与因肾衰竭导致的血液透析需求增加及住院时间延长显著相关（P值<0.05）。住院时间可独立预测死亡率，比值比为0.514（95%置信区间0.328至0.805；P = 0.004）。
需要对临床和实验室参数进行早期评估，以识别各种并发症（血液和神经方面），因为这些并发症可能延长住院时间，导致死亡率增加。
