中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2014年
14期
1671-1673
,共3页
王威%陈泉芳%巫艳彬%李其斌%苌海华%廖园莉%白玉龙%黄锟
王威%陳泉芳%巫豔彬%李其斌%萇海華%廖園莉%白玉龍%黃錕
왕위%진천방%무염빈%리기빈%장해화%료완리%백옥룡%황곤
蛇咬伤%眼镜蛇科%眼镜蛇神经毒素蛋白质类%眼镜王蛇%银环蛇%疾病特征%入院前急救
蛇咬傷%眼鏡蛇科%眼鏡蛇神經毒素蛋白質類%眼鏡王蛇%銀環蛇%疾病特徵%入院前急救
사교상%안경사과%안경사신경독소단백질류%안경왕사%은배사%질병특정%입원전급구
Snake bites%Elapidae%Cobra neurotoxin proteins%King Cobra%Bungarus multicinctus%Disease attrib-utes%Prehospital emergency care
目的：分析广西境内两种常见神经毒类毒蛇咬伤中毒的临床特点，总结其院前急救策略，为临床提供参考。方法选择2007-2012年在我科急诊抢救与住院的102例眼镜王蛇与银环蛇咬伤中毒患者，根据咬伤蛇类将患者分为眼镜王蛇组35例和银环蛇组67例，对比两组患者的院前急救措施、就诊时间、出现呼吸肌麻痹时间、伤情分级、临床表现、呼吸机治疗情况、预后情况及院外与院内死亡率等。结果两组患者的性别、年龄、院前急救措施及就诊时间比较，差异均无统计学意义（ P ﹥0.05）。眼镜王蛇组危重型患者所占比例高于银环蛇组（80.00％和58.21％，P＝0.028）。两组患者均出现了全身症状，眼镜王蛇组局部肿痛发生率（8.57％和0，P＝0.015）、多器官功能障碍综合征（MODS）发生率（20.00％和5.97％，P＝0.030）高于银环蛇组，出现呼吸肌麻痹时间短于银环蛇组〔（3.8±2.2） h和（7.1±8.4） h，P＝0.042〕。眼镜王蛇组治愈率低于银环蛇组（77.14％和95.52％），死亡率高于银环蛇组（22.86％和4.48％），且眼镜王蛇组院外死亡率高于银环蛇组（11.43％和1.49％，P＝0.027）。结论相对于银环蛇，被眼镜王蛇咬伤患者病情更为凶险，出现呼吸肌麻痹的时间更短，MODS发生率及院外死亡率更高，医务工作者应充分认识呼吸机辅助呼吸治疗的关键性，加强神经毒类毒蛇咬伤院前急救策略的宣教。
目的：分析廣西境內兩種常見神經毒類毒蛇咬傷中毒的臨床特點，總結其院前急救策略，為臨床提供參攷。方法選擇2007-2012年在我科急診搶救與住院的102例眼鏡王蛇與銀環蛇咬傷中毒患者，根據咬傷蛇類將患者分為眼鏡王蛇組35例和銀環蛇組67例，對比兩組患者的院前急救措施、就診時間、齣現呼吸肌痳痺時間、傷情分級、臨床錶現、呼吸機治療情況、預後情況及院外與院內死亡率等。結果兩組患者的性彆、年齡、院前急救措施及就診時間比較，差異均無統計學意義（ P ﹥0.05）。眼鏡王蛇組危重型患者所佔比例高于銀環蛇組（80.00％和58.21％，P＝0.028）。兩組患者均齣現瞭全身癥狀，眼鏡王蛇組跼部腫痛髮生率（8.57％和0，P＝0.015）、多器官功能障礙綜閤徵（MODS）髮生率（20.00％和5.97％，P＝0.030）高于銀環蛇組，齣現呼吸肌痳痺時間短于銀環蛇組〔（3.8±2.2） h和（7.1±8.4） h，P＝0.042〕。眼鏡王蛇組治愈率低于銀環蛇組（77.14％和95.52％），死亡率高于銀環蛇組（22.86％和4.48％），且眼鏡王蛇組院外死亡率高于銀環蛇組（11.43％和1.49％，P＝0.027）。結論相對于銀環蛇，被眼鏡王蛇咬傷患者病情更為兇險，齣現呼吸肌痳痺的時間更短，MODS髮生率及院外死亡率更高，醫務工作者應充分認識呼吸機輔助呼吸治療的關鍵性，加彊神經毒類毒蛇咬傷院前急救策略的宣教。
목적：분석엄서경내량충상견신경독류독사교상중독적림상특점，총결기원전급구책략，위림상제공삼고。방법선택2007-2012년재아과급진창구여주원적102례안경왕사여은배사교상중독환자，근거교상사류장환자분위안경왕사조35례화은배사조67례，대비량조환자적원전급구조시、취진시간、출현호흡기마비시간、상정분급、림상표현、호흡궤치료정황、예후정황급원외여원내사망솔등。결과량조환자적성별、년령、원전급구조시급취진시간비교，차이균무통계학의의（ P ﹥0.05）。안경왕사조위중형환자소점비례고우은배사조（80.00％화58.21％，P＝0.028）。량조환자균출현료전신증상，안경왕사조국부종통발생솔（8.57％화0，P＝0.015）、다기관공능장애종합정（MODS）발생솔（20.00％화5.97％，P＝0.030）고우은배사조，출현호흡기마비시간단우은배사조〔（3.8±2.2） h화（7.1±8.4） h，P＝0.042〕。안경왕사조치유솔저우은배사조（77.14％화95.52％），사망솔고우은배사조（22.86％화4.48％），차안경왕사조원외사망솔고우은배사조（11.43％화1.49％，P＝0.027）。결론상대우은배사，피안경왕사교상환자병정경위흉험，출현호흡기마비적시간경단，MODS발생솔급원외사망솔경고，의무공작자응충분인식호흡궤보조호흡치료적관건성，가강신경독류독사교상원전급구책략적선교。
Objective To analyze the clinical features of poisoning from common nerve poison snake bites and summarize its pre - hospital care strategy in Guangxi province. Methods A total of 102 patients hospitalized due to bites from king cobra or bungarus multicinctus from 2007 to 2012 were divided into groups A(bitten by king cobra,n =35),B(bitten by bungarus multicinctus,n = 67). Pre - hospital emergency measures,treatment time,time of respiratory muscle paralysis onset, injury classifications,clinical manifestations,ventilator treatment,prognoses,mortalities in or out of hospital were compared between 2 groups. Results There was no significant difference in gender,age,pre - hospital emergency measure,treatment time between 2 groups(P ﹥0. 05). The proportion of critically - ill patients was higher in group A than in group B(80. 00% vs. 58. 21%,P =0. 028). Both groups had systemic symptoms,but the incidences of local selling,multiple organ dysfunction syndrome(MODS)were higher in group A than in group B(8. 57% vs. 0,P = 0. 015;20. 00% vs. 5. 97%,P = 0. 030), and time of respiratory muscle paralysis onset shorter〔(3. 8 ±2. 2)h vs. (7. 1 ±8. 4)h,P =0. 042〕,the curative rate lower (77. 14% vs. 95. 52%),mortality rate higher(22. 86% vs. 4. 48%),and out - of hospital death rate higher(11. 43% vs. 1. 49%,P =0. 027). Conclusion The patients who were bitten by king cobra have severer condition,shorter time of respiratory muscle paralysis onset,higher incidence of MODS and out - of - hospital death rate as compared with those who were bitten by bungarus multicinctus. Physicians should be fully aware of the importance of ventilator - assisted breathing therapy and strengthen the education about pre - hospital strategy for nerve poison snake bites.
