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小儿蛇咬伤治疗面临的挑战:来自斯里兰卡农村地区医生的观点

Challenges in paediatric snakebite management: physician perspectives from rural Sri Lanka.

作者信息

Gawarammana Indika, Jayamanne Shaluka

机构信息

Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.

Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.

出版信息

Toxicon. 2025 Jul;262:108410. doi: 10.1016/j.toxicon.2025.108410. Epub 2025 May 13.

Abstract

PURPOSE

This study aims to explore the challenges encountered by paediatric emergency care teams in managing snakebite cases in children across three major referral hospitals in Sri Lanka.

METHODS

A qualitative exploratory study was conducted using focus group discussions (FGDs) with physicians who manage paediatric snakebites from Polonnaruwa and Trincomalee District General Hospitals, Kurunegala Teaching Hospital, and peripheral hospitals in the same districts. Thematic analysis was used to identify key challenges related to clinical decision-making, access to healthcare services, availability of antivenom and medical supplies, capacity building, interdisciplinary collaboration, and policy-related issues.

RESULTS

Several challenges were identified, including delays in seeking medical care due to community misconceptions, limited access to antivenom in peripheral hospitals, inadequate intensive care facilities, and gaps in clinical training. Variability in clinical decision-making and the absence of standardized paediatric treatment guidelines further complicated management. Participants emphasized the need for interdisciplinary collaboration, improved referral networks, and targeted educational interventions to address these gaps.

CONCLUSIONS

Paediatric snakebite management in Sri Lanka is hindered by systemic, infrastructural, and educational challenges. Strengthening healthcare infrastructure, ensuring equitable access to antivenom, implementing standardized treatment protocols, and enhancing training programs for healthcare providers are crucial steps in improving patient outcomes. Policy-level interventions and community education initiatives are necessary to mitigate delays in care-seeking and enhance awareness.

摘要

目的

本研究旨在探讨斯里兰卡三家主要转诊医院的儿科急诊护理团队在处理儿童蛇咬伤病例时遇到的挑战。

方法

采用焦点小组讨论(FGD)进行定性探索性研究,讨论对象为来自波隆纳鲁沃和亭可马里地区综合医院、库鲁内格勒教学医院以及同一地区周边医院的处理儿科蛇咬伤的医生。采用主题分析法确定与临床决策、医疗服务可及性、抗蛇毒血清和医疗用品的可用性、能力建设、跨学科协作以及政策相关问题有关的关键挑战。

结果

确定了若干挑战,包括由于社区误解导致寻求医疗护理的延迟、周边医院抗蛇毒血清获取受限、重症监护设施不足以及临床培训方面的差距。临床决策的差异以及缺乏标准化的儿科治疗指南使管理工作更加复杂。参与者强调需要跨学科协作、改善转诊网络以及有针对性的教育干预措施来弥补这些差距。

结论

斯里兰卡儿科蛇咬伤的管理受到系统、基础设施和教育方面挑战所阻碍。加强医疗基础设施、确保抗蛇毒血清的公平可及性、实施标准化治疗方案以及加强对医疗服务提供者的培训计划是改善患者治疗效果的关键步骤。政策层面的干预措施和社区教育倡议对于减少寻求护理的延迟和提高认识是必要的。

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