广西境内两种常见神经毒类毒蛇咬伤中毒的临床特点与院前急救策略分析

摘要

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。%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.