Ribeiro L A, Albuquerque M J, de Campos V A, Katz G, Takaoka N Y, Lebrão M L, Jorge M T
Departamento de Clínica Médica da Universidade Federal de Uberlândia, MG.
Rev Assoc Med Bras (1992). 1998 Oct-Dec;44(4):312-8. doi: 10.1590/s0104-42301998000400010.
The prognostic factors and the causes for obit occurrence in ophidian envenoming are yet not completely clear.
To determine the prognostic factors and the most probable causes for obit occurrence in ophidian envenoming.
In the State of São Paulo were notified 12,639 cases of accidents by venomous snakes from 1988 to 1993. There were 43 deaths (0.34%). The variables from the accident notification reports were compared with the promptuary notes and/or with the death records (in lethal cases).
The snake genus was classified in 11,297 accidents and in 41 from the lethal ones. Bothrops was responsible for 9,828 (87%) accidents and 28 (68.3%) deaths, Crotalus for 1,359 (12.0%) accidents and 13 deaths (31.7%) and Micrurus for 110 (1%) accidents and no death (p < 0.05). The information regarding to sex and age of the patients was available, respectively, in 12,620 and 12,527 accidents and in all lethal ones. There were 9,783 (77.5%) male patients in the accidents and 35 (81.4%) in the lethal cases (p > 0.05). Regarding to age, 15.9% of the patients and 41.8% of the ones who died were 50 years-old or more (p < 0.05). The most frequently bitten anatomic regions were: foot (42.2%), hand (20.6%), leg (17.6%), and ankle (13.1%) in the accidents, and foot (35.7%) and leg (35.7%) in the lethal cases (p < 0.05). Coagulation disorders occurred in 34 (91.9%) from 37 patients who died (those where this datum was available). The information above was not available in non lethal cases. The most common manifestations and complications implicated as possible death causes were: acute renal failure (34-79.1%), acute respiratory failure (28-65.1%), shock (18-41.9%), and sepsis (18-41.9%). Among all lethal cases but one without information, 29.4% of the patients died within the first two days after bite and 67.6% within the first 5 days. Acute respiratory failure was most common among the patients who died owing to crotalic envenoming, and sepsis was only seen in bothropic envenoming.
Most of the accidents and obits are caused by Bothrops; Crotalus envenoming, leg bites, and accidents in 50 year-old patients (or more) are frequently lethal; the most common complication in lethal cases is acute renal failure.
蛇咬伤中毒的预后因素及导致死亡的原因尚未完全明确。
确定蛇咬伤中毒的预后因素及导致死亡的最可能原因。
1988年至1993年，圣保罗州共报告12639例毒蛇咬伤事故。其中43例死亡（0.34%）。将事故报告中的变量与病历记录和/或死亡记录（致死病例）进行比较。
在11297例事故及41例致死事故中对蛇的种类进行了分类。其中，矛头蝮属导致9828例（87%）事故及28例（68.3%）死亡；响尾蛇属导致1359例（12.0%）事故及13例死亡（31.7%）；珊瑚蛇属导致110例（1%）事故，无死亡病例（p<0.05）。分别有12620例和12527例事故以及所有致死病例提供了患者的性别和年龄信息。事故中有9783例（77.5%）男性患者，致死病例中有35例（81.4%）男性患者（p>0.05）。关于年龄，15.9%的患者及41.8%的死亡患者年龄在50岁及以上（p<0.05）。事故中最常被咬的解剖部位为：足部（42.2%）、手部（20.6%）、腿部（17.6%）和脚踝（13.1%），致死病例中为足部（35.7%）和腿部（35.7%）（p<0.05）。37例死亡患者（有该数据的患者）中有34例（91.9%）出现凝血功能障碍。非致死病例未提供上述信息。最常见的可能导致死亡的表现和并发症为：急性肾衰竭（34例，79.1%）、急性呼吸衰竭（28例，65.1%）、休克（18例，41.9%）和败血症（18例，41.9%）。在所有致死病例中，除1例无信息外，29.4%的患者在咬伤后前两天内死亡，67.6%在头5天内死亡。急性呼吸衰竭在响尾蛇咬伤致死患者中最常见，败血症仅在矛头蝮咬伤致死患者中出现。
大多数事故和死亡由矛头蝮属蛇咬伤所致；响尾蛇咬伤、腿部咬伤以及50岁及以上患者发生的事故致死率较高；致死病例中最常见的并发症是急性肾衰竭。
