蛇伤患者出院后的健康问题及相关求医行为：来自斯里兰卡农村的队列研究。
Health issues and related health-seeking behaviours of snakebite patients after hospital discharge: A cohort study from rural Sri Lanka.
机构信息
Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka; South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka.
Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka; South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka; Monash Venom Group, Department of Pharmacology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, 3800, Australia.
出版信息
Toxicon. 2024 Aug 28;247:107840. doi: 10.1016/j.toxicon.2024.107840. Epub 2024 Jul 14.
We aimed to assess the unresolved health issues experienced by a cohort of snakebite survivors and their health-seeking behaviours during the first three months after the snakebite. Patients from the Anuradhapura snakebite cohort admitted to the Teaching Hospital Anuradhapura, Sri Lanka, from July 2021 to June 2022 were recruited. Patients were interviewed over the telephone three weeks and three months post-bite to collect data on unresolved health problems post-discharge, patient's adherence to the review plan, newly experienced health issues, health-seeking behaviours and the effect on daily routine. Only snakebite survivors who could be contacted at both three weeks and three months were included. Of 710 eligible patients, 384 (54%) were contactable at both reviews. On discharge from the hospital, 248/384 (65%) had unresolved effects of the snakebite, including 224/384 (58%) who had local effects. The unresolved health problems were reported by patients bitten by H. hypnale (54%), D. russelii (23%), and unidentified snakes (19%). At three weeks and three months, 98/384 (26%) and 52/384 (14%) still had unresolved local effects of envenoming, respectively. Of 144/384 (38%) who were advised to attend review visits post-discharge, mostly to assess renal function, 118 (82%) complied. 112/384 (29%) patients reported self-motivated treatment seeking for unresolved effects of snakebite over the three months. Of them, 87 (78%) visited Sri Lankan indigenous medical practitioners. Patients missed a median of two working days (IQR: 2-4 days) post-discharge. 26 (6.7%) were unable to return to work at 3 weeks, and five patients at 3 months. In rural Sri Lanka, a significant number of viper bite patients leave hospital with mild persistent local effects, which commonly leads to them seeking further treatment. Despite that, almost all snakebite survivors had returned to work at three months post-bite.
我们旨在评估一组蛇咬伤幸存者在蛇咬伤后三个月内经历的未解决健康问题及其寻求医疗服务的行为。2021 年 7 月至 2022 年 6 月期间，从斯里兰卡安努拉达普拉教学医院收治的安努拉达普拉蛇咬伤队列的患者中招募了研究对象。在咬伤后三周和三个月，通过电话对患者进行访谈，以收集出院后未解决的健康问题、患者对复查计划的依从性、新出现的健康问题、寻求医疗服务的行为以及对日常生活的影响等数据。仅纳入在两周和三个月均能联系到的蛇咬伤幸存者。在 710 名符合条件的患者中，有 384 名（54%）在两次评估时均能联系到。从医院出院时，384 名患者中有 248 名（65%）存在蛇咬伤的未解决影响，其中 224 名（58%）存在局部影响。未解决的健康问题由被 H. hypnale（54%）、D. russelii（23%）和不明身份的蛇（19%）咬伤的患者报告。在三周和三个月时，分别有 98/384（26%）和 52/384（14%）的患者仍存在未解决的局部中毒效应。在出院后被建议进行复查以评估肾功能的 144 名患者中，有 118 名（82%）遵医嘱进行了复查。在三个月内，有 112 名（29%）患者因未解决的蛇咬伤影响而自行寻求医疗服务。其中，87 名（78%）患者前往斯里兰卡本土医疗从业者处就诊。出院后，患者平均错过两个工作日（IQR：2-4 天）。26 名（6.7%）患者在 3 周时无法恢复工作，5 名患者在 3 个月时无法恢复工作。在斯里兰卡农村地区，相当数量的蝰蛇咬伤患者出院时仍存在轻微持续的局部影响，这通常导致他们进一步寻求治疗。尽管如此，几乎所有蛇咬伤幸存者在咬伤后三个月都已恢复工作。
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