广西境内两种竹叶青蛇咬伤中毒患者的临床特点分析

Analysis of Different Clinical Characteristics of Two Kinds of Trimeresurus Stejnegeri Snakebites in Guangxi Province

目的分析广西境内两种竹叶青蛇咬伤中毒患者的临床特点,为临床诊治提供帮助。方法回顾性分析2006年6月—2012年12月我院收治的89例广西境内两种竹叶青蛇咬伤中毒患者的临床资料,其中白唇竹叶青蛇咬伤56例(占62.9%),普通竹叶青蛇咬伤33例(占37.1%)。分析其蛇体外形、临床表现以及治疗情况。结果外形上蛇体两侧腹部纵线纹白唇竹叶青蛇多为白色,普通竹叶青蛇多为黄色,两组比较差异有统计学意义(χ2=50.506,P=0.000)。白唇竹叶青蛇咬伤中毒患者均出现出血症状,12例伴有患肢局部肿胀,7例伴有轻微疼痛,凝血四项检查均出现异常;普通竹叶青蛇咬伤中毒患者6例出现出血症状,出现时间较晚,均有疼痛、患肢局部肿胀症状,6例凝血四项检查异常。伤情分级:白唇竹叶青蛇中毒轻13例,重38例,危5例;普通竹叶青蛇中毒轻27例,重4例,危2例;两组伤情分布情况比较,差异有统计学意义(z=-4.865,P<0.01)。89例竹叶青咬伤中毒患者经治疗后均治愈出院,随访,均无后遗症发生。白唇竹叶青蛇咬伤比普通竹叶青咬伤患者住院时间长、住院费用高,差异均有统计学意义(P<0.01)。结论白唇竹叶青蛇体两侧腹部纵线纹多为白色,咬伤病情较重,全身出血多见、早发,需及早处理;普通竹叶青两侧腹部纵线纹多为黄色,咬伤病情较轻,以患处疼痛、肿胀多见,全身出血症状少见、迟发,建议临床医学观察时间为2周。

Objective To analyze and summarize the different clinical characteristics of two kinds of trimeresurus stej- negeri snakebites in Guangxi province in order to provide reference for treatment. Methods Clinical data of 89 cases trimeresurus stejnegeri snakebites admitted to our hospital from June 2006 to December 2012 were retrospectively analyzed. Among them, 56 （62. 9% ） eases were snakebites of trimeresurus albolabris and 33 （37.1% ） cases were snakebites of common trimeresurus stej- negeri. The body shape of snakes, clinical manifestations and treatment were analyzed. Results The abdominal longitudinal pat- terns in both sides of the trimeresurus albolabris mostly were white while the common trimeresurus stejnegeri were yellow. The difference was statistically significant （X2 = 50. 506, P = 0. 000） . The snakebites of trimeresurus albolabris all had hemorrhage, with 12 cases having local swelling, 7 cases having mild painand all of them having abnormal results of four coagulation tests. While for the snakebites of common trimeresurus stejnegeri, 6 cases had hemorrhage at a relatively later time, all cases had pain and swelling and 6 cases had abnormal results of four coagulation tests. In terms of injury classification, for snakebites of tri- meresurus albolabris, 13 cases were mild, 38 cases were serious and 5 eases were critically serious; while for snakebites of trim- eresurus stejnegeri, 27 cases were mild, 4 cases were serious and 2 cases were critically serious. The difference was statistically significant （z = -4. 865, P 〈 0. 01 ） . 89 cases of snakebites of trimeresurus stejnegeri were all discharged from hospital after treatment, and showed no sequelae during following up. The eases of trimeresurus albolabris snakebites had longer hospital stay and higher cost compared with the eases of common trimeresurus stejnegeri snakebites, and the difference was statistically signifi- cant （P 〈 0. 01 ） . Conclusion The abdominal longitudinal patterns in both sides of the trimeresurus albolabris are mostly white. The trimeresurus albolabris snakebites are severe, mostly with early - onset of systemic bleeding, and need to be treated early. The abdominal longitudinal patterns in both sides of the common trimeresurus stejnegeri are mostly yellow. The common trim- eresurus stejnegeri snakebites are mild, mostly with late onset of systemic bleeding, and need to be continuously observed for 2 weeks.