摘要
目的调查北方城市蛇伤的网络防治情况。方法调查急救部12年(1992年2月～2006年12月)急诊科蛇伤患者的临床资料,总结其网络防治的特点。结果急诊蛇伤数量逐年上升,近两年明显增加;发病季节以夏季为多,但蛇贩受伤在节假日较多。651例患者,男428例,女223例;年龄0.6～69.0岁,平均(38.3±19.8)岁。通过蛇伤救治网络前来就诊者占77.42%(504/651);蛇伤地理分布:北京地区518例;外省市133例:其中河北省99例(承德21、唐山19、保定19、张家口17、其他23例)、天津12例、山西省10例、内蒙古自治区5例、山东省5例、辽宁省2例;蛇伤分类:无毒蛇咬伤101例、毒蛇伤550例;轻伤398例,重度141例,危重11例(5例为蝰蛇伤、5例为蝮蛇伤、1例为五步蛇伤)。咬伤部位:上肢341例,下肢289例,躯干部19例、会阴部1例、舌1例;就诊前局部伤口经处理188例,未做处理463例。4h以内就诊49例,4～24h就诊447例,24h以后就诊155例;症状体征和受累脏器:疼痛477例(86.73%)、伤肢肿胀540例(98.18%),出现单个系统或脏器功能异常263例(47.82%)、多个系统或脏器异常46例(8.36%)。11例危型患者在出现呼吸、循环、血液系统并发症后进行透析、输血、呼吸机辅助呼吸等。治疗结果:毒蛇咬伤的治愈率为99.45%(547/550)、致残率为0.72%(4/550)、死亡率为0.54%(3/550)。3例死亡患者中1例为退院,死亡率为0.8%(3/391)。结论城市内贩蛇业的发展使蛇伤完全没有季节特点,蛇伤的种类也与蛇的自然分布情况完全不同;蛇伤救治要在技术,药品上做好充分的准备。应健全蛇伤救治网络。
Objective To search the strategy of emergency treatment of snake - bite injuries in northern cities. Methods The data of patients with snake - bite injuries treated in emergency department from 1992 to 2006 were analyzed retrospectively. Results The amount of snake - bites in northern cities of China has been going up and obviously increasing in recent two years. Most of them happened in summer, but the most cases of snake vendors occurred in the festivals or vacations. Among the 651 cases, 428 were male, 223 were female; and aged 0.6 ～69. 0 （38. 3 ± 19. 8） years. The cases who visited through snake bite aid network accounted for 77.42% （504/651）. Geographical distribution： In Beijing area there occurred 518 eases, in Hebei province 99, in Tianjin City 12, in Shanxi province 10, in Mongolia 5, in Shandong province 5, and in Liaoning province 5. Classification of snake - bites： 101 eases of 651 were non - poisonous snake - bites. Most of 550 cases with poisonous snake -bites were caused by the family Viperidae ： 631 cases by cortalinae Agkistrodon blomhoffii Boie subfamily, 6 cases by vipers; 3 cases by hundred pace snake, 3 cases by cobra and 1 case by bungarus muhicinctus. There were 398 mild cases, 141 sever cases and 11 critical cases （including 5 cases of viper - bites, 5 cases of Pallas pit Viper - bites, and 1 case of hundred pace snake- bites）. Wounded region： There were： 341 cases whose wounds were in the upper limb, 289 cases in the lower limbs, and 19 cases in the trunk, 1 case in the perineum and 1 case in the tongue. Totally 188 cases had been managed on the wound and 463 cases had not before visit. After injury, 49 of all cases were sent to hospital within 4 hours, 447 cases during 4 -24 hours, and 155 cases beyond 24 hours. Symptom -sign and involved organ： Local pain occurred in 477 （86. 73% ） cases and swollen limbs occurred in 40 （98. 18% ） cases. There were 263 （47.82%） cases with dysfunction of one system or organ and 46 （8. 36% ） with dysfunctions of more than 2 systems or organs. There were 11 cases with respiratory or circulatory or hematological complications that were treated in SICU with dialysis, blood transfusion and ventilation support. Results of treatment ： The cure rate was 99.45% （547/550）, mutilate rate was 0. 72% （4/550） and the fatality rate was 0. 54% （3/550）. Conclusion Development in vending snake in city causes the snake - bites to happen in every season, and the sorts of snake - bites are not consistent with natural distribution of snakes. Thus we should prepare well in management of snake - bites in skill and drugs, and build up the management net.
出处
《中国全科医学》
CAS
CSCD
2007年第17期1453-1455,共3页
Chinese General Practice
关键词
蛇咬伤
蝮蛇属
急诊处理
Snake bites
Agkistrodon
Emergency treatment
