血常规和超敏C反应蛋白检测结果在毒蛇咬伤治疗前后的变化规律

目的探讨各种毒蛇咬伤患者治疗前后血常规和血清超敏C反应蛋白(hs-CRP)的变化规律。方法选择近2年住院治疗、属于何种蛇伤诊断明确的毒蛇咬伤患者作为研究对象,这些患者在治疗前后均进行血常规和血清hs-CRP检测,按蛇种、时段及病情对检测结果作出统计分析。结果治疗前仅蝰蛇咬伤患者WBC明显升高,治疗后第1、2天5种毒蛇咬伤患者WBC均显著升高(P0.01),治疗后第4天该指标均有下降趋势,但检测值仍高于正常参考范围。治疗前后5种毒蛇咬伤患者RBC和HGB均在正常水平,没有明显变化。竹叶青蛇咬伤患者在治疗前、蝰蛇咬伤患者在治疗前后出现血小板(PLT)减少(P0.05)。hs-CRP水平治疗前以蝰蛇咬伤患者较高、治疗后以眼镜蛇咬伤患者最高,差异有统计学意义(P0.05)。结论 5种毒蛇咬伤患者治疗前后基本上无贫血症状,但大多数患者出现炎症反应,竹叶青蛇、特别是蝰蛇咬伤患者PLT减少比较严重。     

凝血功能在毒蛇咬伤治疗前后变化规律的研究

目的探讨各种毒蛇咬伤患者治疗前后凝血功能的变化规律。方法选择近2年住院治疗、属于何种蛇伤诊断明确的毒蛇咬伤患者226例为研究对象,其中银环蛇咬伤39例,竹叶青蛇咬伤76例,眼镜蛇咬伤47例,眼镜王蛇咬伤24例,蝰蛇咬伤40例。这些患者在治疗前后各时段均进行5项凝血指标检测,按蛇种、时段及病情对检测结果进行统计分析。结果银环蛇咬伤轻症患者与重症患者比较,仅治疗前重症患者D二聚体(D-D)水平明显高于轻症患者,差异有统计学意义(P0.05);竹叶青蛇咬伤重症患者治疗前血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、和D-D水平升高、纤维蛋白原(Fib)水平降低,Fib和D-D水平在治疗前后与轻症差异有统计学意义(P0.05);眼镜蛇和眼镜王蛇咬伤患者各项指标在治疗前后差异无统计学意义(P0.05),仅眼镜蛇咬伤重症患者D-D水平在治疗前与轻症比较差异有统计学意义(P0.05);蝰蛇咬伤患者不论轻症或重症5项凝血指标的变化均很大,在治疗前后之间和轻重之间的多项比较差异均有统计学意义(P0.05)。结论银环蛇、眼镜蛇和眼镜王蛇咬伤对凝血功能影响很少;竹叶青蛇咬伤重症患者可引起较严重的凝血功能异常,但治疗后恢复较快;蝰蛇咬伤可引起极大的凝血功能异常,且治疗后恢复慢。     

毒蛇咬伤患者尿常规变化的观察

目的探讨各种毒蛇咬伤患者尿常规的变化情况。方法选择近2年住院治疗、何种蛇伤诊断明确的毒蛇咬伤患者共164例作为研究对象,入院后24h内检测患者晨尿10项,同时使用显微镜镜检确诊,按蛇伤种类对检测结果作统计分析。结果5种毒蛇咬伤均有部分患者不同程度地出现尿蛋白、尿红细胞和尿白细胞阳性,但以蝰蛇咬伤尿蛋白、尿红细胞和尿白细胞阳性检出率最高(分别为62.5%、68.7%和46.9%),与其他4种蛇伤比较,差异有统计学意义(P0.05)。尿蛋白和尿红细胞阳性的严重程度亦以蝰蛇咬伤的患者最多,与其他4种蛇伤比较,差异有统计学意义(P0.05)。结论 5种毒蛇咬伤均可使部分患者肾脏受损而出现尿常规变化,但以蝰蛇咬伤患者肾脏受损最重而使尿常规变化最大。     

蝰蛇咬伤所致肝肾功能、凝血功能及血液常规变化的分析

目的:探讨蝰蛇咬伤患者肝肾功能、凝血功能及血液常规的改变及其临床意义.方法:回顾性分析2017年6月～2020年5月住院的蝰蛇蛇伤患者的临床实验资料,以同期健康体检人员为对照组对肝肾功能、凝血功能及血液常规检测数据进行比较.结果:蛇伤患者研究组肝功能指标ALT、AST、TBIL以及IBIL均高于对照组,差异明显,存在统...     

2014—2018年广州周边地区圆斑蝰蛇咬伤流行病学分析

目的了解圆斑蝰蛇咬伤患者在广州周边地区的流行病学特征,为防治圆斑蝰蛇咬伤提供依据。 方法对广州医科大学附属第一医院急诊科2014年1月1日至2018年12月31日收治的圆斑蝰蛇咬伤事件的流行病学特征进行描述性分析。采用线性相关分析的方法分析咬伤后就诊时间与咬伤后出现急性肾损伤时间的相关性。 结果5年共收治毒蛇伤1481例,死亡3例,其中43例圆斑蝰蛇咬伤,死亡2例,占毒蛇伤总死亡率的66.7%（2/3）;患者分布以广州珠三角地区（肇庆、云浮、佛山、江门）伤者居多,占74.4%,9~11月是咬伤高发月份,占44.2%（19/43）,被咬伤者以农民为主,占53.5%（23/43）,50~69岁为主要高发年龄,下肢咬伤占67.4%（29/43）,蛇伤严重程度评分重度病例占74.4%（32/43）。咬伤后就诊时间与咬伤后出现急性肾损伤的时间存在显著相关性（r=0.719,P<0.01）。 结论圆斑蝰蛇咬伤是广州周边地区毒蛇伤的主要死亡原因,应对高发月份、高发地区、高发人群及高发部位进行重点监测和干预,提高公众的自我保护能力,一旦发生圆斑蝰蛇咬伤,应立即到正规医院接受针对性诊治,必要时接受血液净化治疗。     

湖北地区毒蛇咬伤流行病学调查及随访分析

目的:了解湖北地区毒蛇咬伤流行病学特征及蛇伤患者出院后恢复情况，为本地区的蛇伤救治策略提供依据。方法:统计我院2017—2021年收治的2178例毒蛇咬伤患者的临床资料，回顾性分析年就诊量、性别年龄、地区分布、就诊时间、受伤时间、蛇种分布、费别费用、抗蛇毒血清剂量及住院相关指标统计，并电话随访573例出院患者，统计指标包括是否再次就医、复查检验指标、伤口愈合时间、肢体消肿时间及并发症。结果:湖北地区及周边蛇伤事件主要发生在4—10月份，最常见的为蝮蛇咬伤，其次为不明毒蛇类咬伤；昂贵的抗蛇毒血清费用是就诊费用高的主要原因，这对蛇伤患者造成了沉重的经济压力。出院后常见的并发症有血清病(12.04%)、伤口不愈合(8.20%)和肢体疼痛(9.25%)。结论:了解本地区的毒蛇伤流行病学特点及蛇伤患者出院后恢复情况，能够制定符合本地区的蛇伤救治策略。     

圆斑蝰蛇咬伤病人的护理

圆斑蝰蛇俗称“百步蛇”、“古钱窗”等,生性凶猛,分布于我国南方各省,多栖息于田野中。泉州地处南方,为亚热带季风气候,每年的4~10月份为毒蛇咬伤的发病期。我院为闽南地区蛇伤患者首选的救治医院,统计2006年4月至2007年4月收治的254例蛇伤患者中有96例为圆斑蝰蛇咬伤,占比达37.79%。现就圆斑蝰蛇咬伤病人的护理总结如下。1临床资料1.1一般资料2006年4月至2007年4月共收治圆斑蝰蛇咬伤病人96例,其中男性67例,女性29例,年龄15~72岁。痊愈95例,死亡1例。住院天数:最长24 d,最短2 d。急性肾功能衰竭3例,出现蛇伤弥散性血管内凝血(DIC)8例。1…     

针药并用治疗血循毒蛇咬伤致肢体肿痛

我科自 1 999年起对血循毒蛇咬伤致肢体肿痛的患者进行了针药并用的临床研究 ,现报告如下。1　临床资料全部来自我院蛇伤治疗中心 1 999年 1 1月至 2 0 0 0年 1 0月的留观和住院病人。⑴蛇咬伤的病史 ;⑵病人诉述为血循毒类毒蛇 (蝰蛇、竹叶青蛇、五步蛇 )咬伤且所述毒蛇的特征与该种毒蛇相符 ;或蛇体经医务人员鉴定为该种毒蛇 ;⑶局部出现红肿、疼痛。将入选病例69人按不同蛇种咬伤的单双号单盲分为两组。单号为治疗组 ,双号为对照组 (如收治第 1例竹叶青蛇咬伤者为治疗组 ,第 2例则为对照组 ,以此类推 ,其他蛇种者也如此 )。其年龄、就诊…     

毒蛇咬伤的治疗初探

毒蛇咬伤处理不及时或处理不当常致死亡。诊断问题:虽然我们可以从蛇伤的局部症状和全身症状等方面来大体判断蛇伤的蛇种,但由于各人的经验和经历不同,未必能完全、准确。有时仅能分出是属于神经毒的毒蛇咬伤,还是属于血液循环毒的毒蛇咬伤,或者是属于混合毒的毒蛇咬伤。     

广西地区两种常见血循毒蛇咬伤患者的临床特点分析

目的:分析广西地区两种常见血循毒蛇咬伤患者的临床特点,为蛇伤的诊治提供帮助。方法:回顾2007~2015年我院收治的208例竹叶青蛇和五步蛇咬伤患者的临床资料,根据咬伤蛇类将患者分为竹叶青蛇组(165例)和五步蛇组(43例),对比分析2组患者的伤情分级、临床表现、凝血功能指标及预后等。结果:五步蛇组重型及危重型患者所占比例高于竹叶青蛇组(均P0.05);五步蛇组局部出血发生率、伤口坏死、溃疡发生率、重要脏器出血发生率、休克、多器官功能障碍综合征(MODS)发生率、病死率高于竹叶青蛇组(均P0.05)。五步蛇组凝血功能异常高峰早于竹叶青蛇组(48h和72h);蛇咬伤后12h,24h,48h,五步蛇组凝血酶原时间(PT)、活化部分凝血酶时间(APTT)较竹叶青蛇组延长(均P0.05);蛇咬伤后12h,1d,2d,3d,5d,7d,五步蛇组血小板计数(PLT)、血红蛋白量(HGB)明显低于竹叶青蛇组(均P0.01),竹叶青蛇组纤维蛋白原(Fg)低于五步蛇组(P0.05)。结论:与竹叶青蛇咬伤患者相比,五步蛇咬伤患者病情发展迅速,凝血功能异常高峰出现早,存在明显的血小板下降,出血发生率高,病情更危重,预后更差。     

Acute anuric renal failure after pigmy rattlesnake bite

Acute renal failure has been known to follow viper bites in up to 30% of patients, but we believe we have reported the first case in which anuric renal failure developed after the bite of a pigmy rattlesnake. Our patient's renal failure is thought to have been due to a combination of rhabdomyolysis and intrarenal thrombosis caused by DIC. Prompt surgical debridement should be offered to the victim of a bite by any poisonous snake, and antivenin should be administered to any patient with signs of systemic envenomation, with close monitoring for signs of allergic reactions.     

2型糖尿病和糖尿病肾病患者相关检验指标的变化趋势

目的分析2型糖尿病(T2DM)和糖尿病肾病(DN)患者相关检验指标的变化趋势。方法检测167例T2DM患者的尿微量清蛋白(M-Alb)、血糖和肾功能等指标,再将其按尿M-Alb排泄率分为3组(单纯DM组、早期DN组和临床DN组),对结果进行比较和分析。结果单纯DM组患者的年龄小于早期DN组和临床DN组(P0.05)。尿M-Alb和尿蛋白阳性率以临床DN组最高,3组差异有统计学意义(P0.05)。单纯DM组和早期DN组之间血糖指标差异不显著,临床DN组显著高于单纯DM组和早期DN组(P0.05)。单纯DM组尿素(Urea)和肌酐(Cr)水平明显低于早期DN组和临床DN组,3组间差异有统计学意义(P0.01)。结论 DN越重,患者尿M-Alb、血糖和肾功能指标就越高,尿蛋白和尿糖阳性率也越高,肾功能受损的趋势也越明显。     

Suspected snakebite: One year prospective study of emergency department presentations

Aim: Snakebite is an uncommon, but potentially life‐threatening condition. The more common clinical scenario is suspected snake‐bite. Our aim was to characterise the epidemiology, diagnosis and management of patients with suspected snakebites. Methods: Prospective cohort study of patients presenting with suspected snakebites to a tertiary referral hospital serving a large rural region in tropical northern Australia where a standard admission protocol for suspected snakebites is used. Results: Of 70 suspected snakebite cases, there were 45 definite bites: three severe envenomings (two western brown snakes [Pseudonaja nuchalis] and one mulga snake [Pseudechis australis]); seven mild/moderate envenomings by other snakes, two non‐envenomings by identified P. nuchalis, five bites by identified non‐venomous snakes and 28 definite bites without envenoming. The remaining 25 cases were either suspected bites (8), unlikely bites (15) and two people hit by snakes. Definite snake‐bites occurred throughout the year, peaking in May and December. There were three severe envenomings (mainly coagulopathy), requiring antivenom treatment, but no deaths or major complications. Most patients had appropriate investigations. Of 47 venom detection kit swabs collected, 34 were not tested, venom was not detected in nine and was positive in the three envenomings with one false‐positive tiger snake. Whole blood clotting time was highly sensitive for procoagulant coagulopathy and envenoming in this study. Median length of time from the bite to discharge was 20 h (interquartile range: 12–27). Conclusions: The study shows that although suspected snakebite was common, severe envenoming occurred in less than 5% of cases. The study supports the proposition that a structured approach and admission policy of suspected snakebites leads to the appropriate management of severe envenoming, with no cases discharged early and no cases of non‐envenoming treated with antivenom.     

Neurotoxicity in Russell’s viper (Daboia russelii) envenoming in Sri Lanka: a clinical and neurophysiological study

Context: Russell’s viper is more medically important than any other Asian snake, due to number of envenoming’s and fatalities. Russell’s viper populations in South India and Sri Lanka (Daboia russelii) cause unique neuromuscular paralysis not seen in other Russell’s vipers. Objective: To investigate the time course and severity of neuromuscular dysfunction in definite Russell’s viper bites, including antivenom response. Methodology: We prospectively enrolled all patients (>16 years) presenting with Russell’s viper bites over 14 months. Cases were confirmed by snake identification and/or enzyme immunoassay. All patients had serial neurological examinations and in some, single fibre electromyography (sfEMG) of the orbicularis oculi was performed. Results: 245 definite Russell’s viper bite patients (median age: 41 years; 171 males) presented a median 2.5?h (interquartile range: 1.75–4.0?h) post-bite. All but one had local envenoming and 199 (78%) had systemic envenoming: coagulopathy in 166 (68%), neurotoxicity in 130 (53%), and oliguria in 19 (8%). Neurotoxicity was characterised by ptosis (100%), blurred vision (93%), and ophthalmoplegia (90%) with weak extraocular movements, strabismus, and diplopia. Neurotoxicity developed within 8?h post-bite in all patients. No bulbar, respiratory or limb muscle weakness occurred. Neurotoxicity was associated with bites by larger snakes (p?<?0.0001) and higher peak serum venom concentrations (p?=?0.0025). Antivenom immediately decreased unbound venom in blood. Of 52 patients without neurotoxicity when they received antivenom, 31 developed neurotoxicity. sfEMG in 27 patients with neurotoxicity and 23 without had slightly elevated median jitter on day 1 compared to 29 normal subjects but normalised thereafter. Neurological features resolved in 80% of patients by day 3 with ptosis and weak eye movements resolving last. No clinical or neurophysiological abnormality was detected at 6 weeks or 6 months. Conclusion: Sri Lankan Russell’s viper envenoming causes mild neuromuscular dysfunction with no long-term effects. Indian polyvalent antivenom effectively binds free venom in blood but does not reverse neurotoxicity.     

蝮蛇咬伤患者早期应用乌司他丁的治疗作用研究

目的探讨乌司他丁对毒蛇咬伤患者的心、肝、肾等重要脏器的保护作用和治疗效果。方法17例蝮蛇咬伤患者,常规治疗组9例,乌司他丁治疗组8例,检测各组治疗前及治疗后3d的血钾、血肌酸磷酸激酶（CK）、血肌酸磷酸激酶同工酶（CK—MB）、血谷丙转氨酶（AIT）、血尿素氮（BUN）、血肌酐（CR）。结果两组患者治疗前各指标差异无显著性（P〉0．05）,3d后乌司他丁治疗组各指标均低于常规治疗组,差异有显著性（P〈0．05）。结论乌司他丁对蝮蛇咬伤患者的心、肝、肾等重要脏器有保护作用。     

毒蛇咬伤患者延续性护理方案的构建

目的 构建毒蛇咬伤患者延续性护理方案,以期改善患者预后、降低再住院率、提高患者生活质量。方法 基于前期的研究基础,通过查阅文献联合咨询外科医师、护理专家拟定毒蛇咬伤延续性护理方案。采用德尔菲法进行两轮专家咨询,根据专家意见对方案内容进修订和完善,形成毒蛇咬伤患者延续性护理方案。结果 最终形成包含3部分和45条目的毒蛇咬伤患者延续性护理方案;两轮专家咨询专家积极系数均为100%;专家权威系数：毒蛇咬伤患者出院依从性日记指导方案为0.888,毒蛇咬伤患者居家自我护理指导方案为0.887,毒蛇咬伤患者综合性护理评估表为0.826;专家协调系数为0.283~0.301;第2轮专家咨询后各条目的重要性赋值为4.12~5.00分,变异系数为0.00~0.248,各条目的可行性性赋值为4.25~5.00分、变异系数为0.00~0.240。结论 构建的毒蛇咬伤患者延续性护理方案具有科学性和可行性,可为毒蛇咬伤患者延续性护理提供依据和指导。     

风湿性心脏病相关临床检验指标的研究

目的探讨相关检验指标与风湿性心脏病(RHD)的关系及临床意义。方法收集236例风湿热引起的心脏损害患者的病案信息,分为3组:RHD组、单纯风湿热组、健康对照组。分别测定这3组患者的肌红蛋白(Mb)、肌钙蛋白I(cTnI)、N-端脑钠肽前体(NT-proBNP)等相关指标。结果在RHD组和单纯风湿热组之间,Mb、cTnI、肌酸激酶同工酶(CK-MB)、NT-proBNP水平差异有统计学意义(P0.05);在RHD组和健康对照组之间,红细胞沉降率(ESR)、风湿因子(RF)、C反应蛋白(CRP)、cTnI、Mb、CK-MB、肌酸激酶(CK)、NT-proBNP水平差异均有统计学意义(P0.05)。以136.17pg/mL作为临界值,NT-proBNP对RHD的诊断敏感度为95.48%,特异度为90.15%,阳性预测值为86.7%,阴性预测值为97.86%。结论 RHD患者血中cTnI、Mb、CK-MB与单纯风湿热组及健康对照组相比明显升高,NT-proBNP浓度的测定是早期诊断RHD的敏感指标。     

Hump-nosed pit viper (Hypnale hypnale) envenoming causes mild coagulopathy with incomplete clotting factor consumption

Context. Limited information exists on the coagulopathy caused by hump-nosed pit viper (Hypnale hypnale) envenoming. Objectives. This study aimed to characterise the coagulopathy in hump-nosed pit viper bites by measuring laboratory clotting times and factor studies. Materials and methods. Cases of hump-nosed pit viper envenoming were included from a prospective cohort study of Sri Lankan snake-bite patients. Patient age, sex, snake identification, time of bite and clinical effects were recorded. Patients did not receive anti-venom because no specific anti-venom to hump-nosed vipers exists. All patients received supportive care and serial 20-min whole blood clotting tests (WBCT20). The prothrombin time (PT), international normalised ratio (INR), activated partial thromboplastin time (aPTT), coagulation factors I, II, V, VII, VIII, IX and X, von Willebrand factor (vWF) antigen and D-Dimer concentrations were measured. The median of highest or lowest test result for each patient was reported with interquartile range (IQR). Results. There were 80 hump-nosed pit viper bites, median age was 37 years (IQR: 26–51 years) and 48 were male. The WBCT20 was positive in one patient. The median highest INR was 1.9 (1.5–2.2; Range: 1.3 to > 12) and median highest aPTT was 54 s (46–72 s; Range: 35–170 s). There was low fibrinogen [median: 1.3 g/L;1, –1.8 g/L; Range: < 0.2–2.9], low factor VIII levels [median: 23%; 16–37%] and low factor V levels [median: 43%; 23–74%]. D-Dimer concentrations [median: 3.4 mg/L; 2–7.4 mg/L] were slightly elevated. Factors II, VII and X and vWF antigen concentrations were normal. Discussion and Conclusions. Hump-nosed pit viper bites result in a mild coagulopathy which is usually not detected by a WBCT20. It is characterised by mild elevation of INR, low fibrinogen and Factors V and VIII which may be consistent with the venom containing a thrombin-like enzyme.     

Exotic snake bites in the Czech Republic—Epidemiological and clinical aspects during 15-year period (1999–2013)

Only one natural venomous snake—the adder viper—lives in the central European region and its bite is usually associated only with mild course of envenoming. Cases of envenoming caused by exotic snakes among their breeders are clinically more important. Objective. The aim of this study was to analyze the epidemiological and clinical aspects of registered venomous bites caused by exotic snakes in the Czech Republic over a period of 15 years (1999–2013). Materials and methods. This is an observational case series. Data have been collected retrospectively from a database and medical charts of the Toxinology Center belonging to the General University Hospital in Prague. Results. In total, 87 cases of exotic snakebites caused by 34 venomous snake species were registered during the study period, coming from 18 genera of Elapinae, Viperinae, and Crotalinae subfamilies. In the cohort, 29 patients (33.3%) developed systemic envenoming and 17 (19.5%) were treated with antivenom. Ten cases of envenoming (11.5%) were considered as potentially life threatening. No patient died due to envenoming caused by exotic snake bites during the study period. Four illustrative cases of envenoming (Echis pyramidum, Dendroaspis polylepis, Protobothrops mangshanensis, and Proatheris superciliaris) are described in detail. Conclusion. Bites caused by exotic snakes resulted in serious and life-threatening envenomings in some patients. Early transfer to the Center, antivenom administration, and support of failing organ functions contributed to favorable outcome of victims.