Downey分级在儿童毒蛇咬伤诊治中的应用

Application of Downey classification used in the diagnosis and treatment of children＇s snakebite

目的分析Downey分级在儿童毒蛇咬伤诊治中的应用，提高儿童毒蛇咬伤的综合诊治水平。方法对重庆医科大学附属儿童医院2005年1月至2011年12月在Downey分级指导下连续收治的76例毒蛇咬伤患儿情况进行回顾性分析，包括流行病学特点、临床症状和体征、诊治经过。作为对照，同时采用国内传统分级方法对该组患儿进行分级，研究二者的相关性。分别研究Downey伤情级别、就诊时间、住院时间、骨筋膜室综合征（OCS）和心肌损害的发生之间的相关性。结果本组76例伤情均发生在4—11月份，受伤时间集中在18：01到00：00（60例，占78．94％），受伤部位以四肢为主（73例，96．05％）。按照Downey系统分类，0级3例（3．95％），I级9例（11．84％），Ⅱ级26例（34．21％），Ⅲ级30例（39．47％），Ⅳ级8例（10．53％），均行针对性的综合治疗，临床治愈74例，伤残2例，无死亡病例。Downey分级与传统分级方法呈正相关（r=0．85，P〈0．05）。就诊时间与住院时间呈正相关（r=0．91，P〈0．05），Downey伤情级别与OCS、心肌损害的发生，就诊时间及住院时间均呈正相关（r=0．90、0．95、0．48、0．96，P均〈0．05）。结论Downey分级可使儿童毒蛇咬伤诊治更加规范，加强预防知识教育、早期诊断和综合对症处理可有效降低儿童毒蛇咬伤后病死率和病残率。

Objective To analyze the application of Downey classification and to improve the diagnosis and treatment for children bitten by venomous snakes. Methods The consecutive 76 snakebite children were treated ac- cording to the guidance of Downey classification in Children＇s Hospital of Chongqing Medical University from Jan. 2005 to Dec. 201]. Their epidemiological and clinical characteristics, treatment and outcomes were reviewed and analyzed. The Chinese traditional classification method was adopted to classify children of snakebites as a contrast at the same time, and the correlation of the 2 methods was studied. Correlations in Downey level, treatment time, length of hospital stay, osteofascial compartment syndrome （ OCS ） and the occurrence of myocardial damage were studied respectively. Results The 76 cases of snakebites all occurred from Apr. to Nov. , the time of injuries focused on the period of 18：01 to00：00 （60 cases,78.94% ）,and limbs were the main injury parts（73 cases,96.05% ）. According to Downey＇s system,patients of grade 0 were 3 cases（3.95% ） ,grade I were 9 cases（ ll. 84% ） ,grade ]] were 26 cases （34. 21% ） , grade ]]I were 30 cases （39.47%） , and grade 1V were 8 cases （ 10.53% ）. All children victims were given comprehensive and symptomatic treatment,in which 74 cases were clinically cured and 2 cases were disabled, but no deaths. There was positive correlation between the traditional classification method and Downey classification method （ r = 0.85, P 〈 0.05 ） , and there was also positive correlation between treatment time and length of hospital stay （ r = 0.91 ,P 〈0.05 ）. There was positive correlation between Downey level and OCS ,the occurrence of myocardial damage, treatment time and length of hospital stay （ r = 0. 90,0. 95,0. 48,0. 96, respectively, all P 〈 0.05 ）. Conclusions The diagnosis and treatment were more specified after using the Downey classification, snake venom poisoning in children is a medical emergency requiring immediate attention, early diagnosis and proper treatment can reduce its fatality and disa- bility rate.