重庆地区毒蛇咬伤继发组织坏死的危险因素分析

Clinical predictors of tissue necrosis following snake bite in Chongqing area

目的分析毒蛇咬伤引起组织坏死的相关危险因素。方法采用回顾性病例对照的方法,收集2019年4~7月我院收治的78例毒蛇咬伤患者的年龄、伤情、病史等临床信息,根据是否继发组织坏死分为坏死组和对照组。采用单因素方法分析两组患者单个因素的差异,筛选高危因素;对可能的多个相关因素再进行Logistic回归分析,进一步确认。结果纳入本研究的78例患者中,15例发生组织坏死。通过单因素分析发现两组分布具有差异性,存在统计学意义的因素包括:年龄[坏死组:(63.7±10.6)岁,对照组:(50.3±18.2)岁,P<0.05]、患肢加压捆扎(χ^2=8.64,P<0.05)、手指(足趾)受伤(χ^2=6.99,P<0.05)。Logistic回归分析明确的高危因素包括:年龄>70岁(OR=9.75,95%可信区间1.24~76.5)、患肢加压捆扎(OR=5.79,95%可信区间1.08~31.0)、手指(足趾)受伤(OR=10.39,95%可信区间1.60~67.35)。结论重庆地区毒蛇咬伤发生组织坏死的危险因素包括高龄、伤后加压包扎、手指(足趾)受伤,对存在高危因素的患者应采取更加积极的治疗策略,以提高治疗效果。

Objective To screen high risk factors associated with tissue necrosis after snakebite in Chongqing area.Methods By retrospective case-control analysis,78 patients with snake bite from April 2019 to July 2019 in our hospital were divided into two groups according to whether secondary tissue necrosis occurred.First,the single factor method was used to analyze the differences of each index between the two groups,and then logistic regression analysis was used to identify the risk factors.Results 78 cases were included in this study,15 cases had tissue necrosis.Through single factor analysis,we found that the statistically significant factors included:age[(63.7±10.6)years old in necrotic group,(50.3±18.2)years old in control group,P<0.05],pressured banding on the limb(χ^2=8.64,P<0.05),injury on fingers or toes(χ^2=6.99,P<0.05);the high-risk factors identified by logistic regression analysis included:age over 70 years old(OR=9.75,95%CI 11.24-76.5),stressed binding on the limb(OR=5.79,95%CI 1.08-31.0),and injury on finger or toe(OR=10.39,95%CI 1.60-67.35).Conclusion For the patients with envenomation in Chongqing area,age more than 70,pressured banding on limb,injury on fingers or toes were at increasing risk of developing necrosis.More aggressive therapy should be taken.