摘要
目的通过总结三种常见神经毒类毒蛇咬伤中毒患者的临床资料,为神经毒类毒蛇咬伤的诊治提供参考。方法收集2015~2021年在广西区内救治的82例被眼镜王蛇、青环海蛇与银环蛇咬伤中毒患者的临床资料,比较三种毒蛇咬伤患者的院前急救措施、就诊时间、严重程度、临床表现、出现呼吸衰竭时间、持续使用呼吸机时间、预后等,并分析三种神经毒类毒蛇咬伤中毒的疾病特征。结果三种毒蛇咬伤的危重型患者比较,眼镜王蛇咬伤所占比例高于青环海蛇组(83.33%、66.67%,P=0.032),青环海蛇组高于银环蛇组(66.67%、56.52%,P=0.028)。三种毒蛇咬伤的患者多器官功能障碍综合征(MODS)发生率比较,眼镜王蛇咬伤患者多器官功能障碍综合征(MODS)发生率高于青环海蛇咬伤患者(27.78%、16.67%,P=0.045),青环海蛇咬伤患者高于银环蛇咬伤患者(16.67%、6.52%,P=0.035)。三种毒蛇咬伤患者出现呼吸衰竭时间比较,眼镜王蛇咬伤患者出现呼吸衰竭时间短于青环海蛇咬伤患者[(1.53±0.52)h、(4.51±1.34)h,P=0.043],青环海蛇咬伤患者短于银环蛇咬伤患者[(4.51±1.34)h、(8.14±2.09)h,P=0.023]。三种毒蛇咬伤患者呼吸机持续使用时间比较,眼镜王蛇咬伤患者呼吸机持续使用时间短于青环海蛇咬伤患者[(37.97±7.74)h、(72.31±9.12)h,P=0.043],青环海蛇咬伤患者短于银环蛇咬伤患者[(72.31±9.12)h、(177.92±25.43)h,P=0.036]。结论三种常见神经毒类毒蛇咬伤中毒患者的病情严重度分级依次为眼镜王蛇、青环海蛇、银环蛇。抗银环蛇毒血清对三种神经毒类毒蛇咬伤中毒疗效均较肯定,呼吸机治疗为主要辅助手段。
Objective The study was to provide reference value for the diagnosis and treatment of neurovenomous snakebite by analyzing the disease characteristics of three common neurotoxic venomous snakebites.Methods A total of 82 patients with snakebite poisoning of Ophiophagus Hannah,Hydrophis cyanocinctus and Bungarus multicinctus who were treated in Guangxi from 2015 to 2021 were selected.The characteristics were statistically analyzed by comparing the pre-hospital first aid measures,visit time,injury classification,clinical manifestations,occurrence time of respiratory muscle paralysis,duration of continuous use of ventilator of the three groups.Results The proportion of critically ill patients in Ophiophagus Hannah was higher than that in Hydrophis cyanocinctus group(83.33%,66.67%,P=0.032),and Hydrophis cyanocinctus group was higher than Bungarus multicinctus group(66.67%,56.52%,P=0.028).The incidence of multiple organ dysfunction syndrome(MODS)in Ophiophagus Hannah group was higher than that in Hydrophis cyanocinctus group(27.78%,16.67%,P=0.045),and Hydrophis cyanocinctus group was higher than Bungarus multicinctus group(16.67%,6.52%,P=0.035).The time of respiratory failure in Ophiophagus Hannah group was shorter than that in Hydrophis cyanocinctus group(1.53±0.52 h,4.51±1.34 h,P=0.043),and Hydrophis cyanocinctus group was shorter than Bungarus multicinctus group(4.51±1.34 h,8.14±2.09 h,P=0.023).The duration of ventilator in Ophiophagus Hannah group was shorter than that in Hydrophis cyanocinctus group(37.97±7.74 h,72.31±9.12 h,P=0.043),and Hydrophis cyanocinctus group was shorter than Bungarus multicinctus group(72.31±9.12 h,177.92±25.43 h,P=0.036).Conclusion The severity of bite poisoning of three common neurotoxic venomous snakes was ranked as Ophiophagus Hannah,Hydrophis cyanocinctus and Bungarus multicinctus.The effects of anti Bungarus multicinctus venomous serum on the three neurotoxic venomous snakes were positive,and ventilator therapy is the main auxiliary means.
作者
张泷丹
黄周
黄东凌
王璠
韦晚霞
吕福
秦年英
农继飞
杨杰
李金城
王威
ZHANG Long-dan;HUANG Zhou;HUANG Dong-ling;WANG Fan;WEI Wan-xia;LV Fu;QIN Nian-ying;NONG Ji-fei;YANG Jie;LI Jin-cheng;WANG Wei(Department of Emergency,the First Affiliated Hospital,Guangxi Medical University,Nanning City,Guangxi Zhuang Autonomous Region,530021,China)
出处
《蛇志》
2022年第1期7-10,共4页
Journal of Snake
基金
广西医疗卫生适宜技术开发项目(项目名称:血液灌流在眼镜王蛇咬伤中毒的应用研究,项目编号:S2017021)。
关键词
眼镜王蛇咬伤
青环海蛇咬伤
银环蛇咬伤
神经毒类毒蛇
临床特征
Ophiophagus Hannah
Hydrophis cyanocinctus
Bungarus multicinctus
Neurotoxicity Nerve poison
Clinical manifestation
