Saborío P, González M, Cambronero M
Hospital Tony Facio Castro, Limón, Costa Rica.
Toxicon. 1998 Feb;36(2):359-66. doi: 10.1016/s0041-0101(97)00076-7.
A retrospective epidemiological analysis is presented of 80 snakebites in children admitted to the Pediatrics Service of Tony Facio Hospital in Limón, Costa Rica, between 1985 and 1995. An overall incidence rate of 20 snakebite accidents per 100,000 inhabitants per year was calculated for the region in that period. However, a higher incidence was described in some counties (36 and 30 cases per 100,000 inhabitants in Talamanca and Siquirres, respectively). Most of the cases occurred in February and November, between 16:00 and 19:00 hr. The mean age of the affected children was 8.67 +/- 2.66 years. No significant difference was found between genders. Thirty-three children affected (41.2%) were members of the local indigenous groups and 31 (38.8%) were residents of Talamanca County. The species of snake responsible were identified in 58.4% of cases, with Bothrops asper being the most important. The lower extremities were the most important primary site affected (86.3%). The most common clinical complications described in the study group were abscess formation (11.25%), necrosis (10%), renal failure (3.75%), compartmental syndrome (2.5%) and anaphylactic shock (1.25%). The overall mortality was 2.5%. Statistical analysis of the risk factors relating to the two most common complications showed that the condition of coming from Talamanca County (P = 0.02), damage in the proximal extremities (P = 0.02), a prothrombin time < 2% (P = 0.01) and serum fibrinogen levels < 100 g/dl (P = 0.01) were risk factors for the development of abscesses. The grade of severity of the snakebite (P = 0.018) and serum fibrinogen levels < 100 g/dl were associated with development of necrosis. All of the patients with necrosis and abscesses also experienced two or more of the risk factors that correlated with a sensitivity of 100% and a specificity of 67% for the development of abscess, and 87% sensitivity and 88% specificity for necrotic complications. According to these data, snakebite complications are a relevant health problem in Costa Rica.
本文对1985年至1995年间在哥斯达黎加利蒙市托尼·法西奥医院儿科收治的80例儿童蛇咬伤病例进行了回顾性流行病学分析。计算得出该地区在该时期蛇咬伤事故的总体发病率为每年每10万居民中有20例。然而，一些县的发病率更高（塔拉曼卡和锡基雷斯每10万居民中分别有36例和30例）。大多数病例发生在2月和11月的16:00至19:00之间。受影响儿童的平均年龄为8.67±2.66岁。未发现性别之间存在显著差异。33名受影响儿童（41.2%）是当地原住民群体成员，31名（38.8%）是塔拉曼卡县居民。在58.4%的病例中确定了造成咬伤的蛇的种类，其中矛头蝮是最重要的。下肢是受影响最主要的部位（86.3%）。研究组中描述的最常见临床并发症为脓肿形成（11.25%）、坏死（10%）、肾衰竭（3.75%）、骨筋膜室综合征（2.5%）和过敏性休克（1.25%）。总死亡率为2.5%。对与两种最常见并发症相关的危险因素进行的统计分析表明，来自塔拉曼卡县（P = 0.02）、近端肢体损伤（P = 0.02）、凝血酶原时间<2%（P = 0.01）和血清纤维蛋白原水平<100 g/dl（P = 0.01）是脓肿形成的危险因素。蛇咬伤的严重程度等级（P = 0.018）和血清纤维蛋白原水平<100 g/dl与坏死的发生相关。所有出现坏死和脓肿的患者也都经历了两种或更多与脓肿形成相关的危险因素，其敏感度为100%，特异度为67%，对于坏死并发症，敏感度为87%，特异度为88%。根据这些数据，蛇咬伤并发症在哥斯达黎加是一个相关的健康问题。
