广西梧州市952例毒蛇咬伤流行病学分析

Epidemiological analysis of 952 venomous snake bite in Wuzhou City of Guangxi Zhuang Autonomous Region

目的分析广西梧州市毒蛇咬伤流行病学特点,以指导毒蛇咬伤的预防与救治。方法采用回顾分析方法,收集2014年1月至2020年12月梧州市中医医院蛇伤科收治的1091例毒蛇咬伤患者的病历资料,包括毒蛇种类、患者性别与年龄、咬伤月份及具体时间、咬伤部位及局部症状等。结果最终纳入临床明确诊断为某种毒蛇咬伤的952例患者的病历资料。952例毒蛇咬伤患者中,以烙铁头蛇(32.98%)、竹叶青蛇(27.84%)和眼镜蛇咬伤(26.26%)为主,其次是银环蛇(6.51%)、眼镜王蛇(3.15%)和五步蛇咬伤(1.58%),红脖颈槽蛇(0.73%)、金环蛇(0.42%)、蝰蛇(0.32%)和蝮蛇咬伤(0.21%)并不多见。952例毒蛇咬伤患者中,男性是女性的2倍〔647例(占67.96%)比305例(占32.04%),男女比例为2.12∶1〕;患者年龄0.8~87.0岁,以40~59岁患者居多(42.44%),其次为≥60岁患者(27.31%)。毒蛇咬伤主要发生在4~11月份(93.59%),以10月份为高峰期(16.39%);咬伤时间以下午(12:00—17:59,30.88%)和晚上(18:00—23:59,33.30%)为主,其次是上午(06:00—11:59,24.69%),凌晨(00:00—05:59)不多见(11.13%);其中烙铁头蛇和银环蛇咬伤发病时间主要集中在18:00—23:59,竹叶青蛇咬伤集中在06:00—11:59,眼镜蛇和眼镜王蛇咬伤集中在12:00—17:59。咬伤部位主要集中在四肢(98.53%),以右侧肢体居多(53.57%);其中烙铁头蛇主要咬伤下肢,眼镜蛇和眼镜王蛇主要咬伤上肢。烙铁头蛇与竹叶青蛇咬伤后的局部症状相似,主要表现为疼痛、肿胀、压痛、伤口周围皮肤温度偏高、渗血渗液等;眼镜蛇咬伤后局部症状表现为疼痛、肿胀、瘀黑、压痛、渗血渗液、发红等;金环蛇和银环蛇咬伤以麻木、轻微疼痛为主,其他局部特征不明显。结论广西梧州市毒蛇咬伤患者以中老年男性为主,毒蛇种类以烙铁头蛇、竹叶青蛇和眼镜蛇为主,大多发生在4~11月份,时间集中在12:00—23:59,以四肢咬伤居多,局部症状主要为疼痛、肿胀、压痛、肤温高、瘀黑等。应结合梧州地区毒蛇咬伤流行病学特点,构筑蛇伤防治体系,加强蛇伤防治知识教育宣传,提高人民群众蛇伤防范意识,并辅助临床诊断与治疗,从而有效降低毒蛇咬伤的发病率、致残率和病死率。

Objective To improve the prevention and treatment of venomous snake bites by analyzing the epidemiological characteristics of venomous snake bite in Wuzhou City,Guangxi Zhuang Autonomous Region.Methods A retrospective analysis was conducted.The medical records of 1091 patients with venomous snake bites admitted to the department of snake wound of Wuzhou Hospital of Traditional Chinese Medicine from January 2014 to December 2020 were collected,including snake species,gender and age of patients,bite time,bite site and local symptom.Results The medical records of 952 patients with a definite clinical diagnosis of snake bite were enrolled.Among the 952 patients with venomous snake bites,the main bites were from Ovophis(32.98%),Trimeresurus(27.84%)and Naja(26.26%),followed by Bungarus multicinctus(6.51%),Ophiophagus Hannah(3.15%)and Agkistrodonhalys(1.58%),and few bites were from Rhabdophis subminiatus(0.73%),Bungarus fasciatus(0.42%),viper(0.32%)and Agkistrodon(0.21%).Of the 952 patients with venomous snake bites,there were almost twice as many males as females[647 cases(67.96%)vs.305 cases(32.04%),with male to female ratio of 2.12∶1].The age of patients ranged from 0.8 to 87.0 years old,with 40-59 years old as the majority(42.44%),followed by≥60 years old(27.31%).Snake bites mainly occurred from April to November(93.59%),with a peak in October(16.39%).The incidence time was mainly afternoon(12:00-17:59,30.88%)and evening(18:00-23:59,33.30%),followed by morning(06:00-11:59,24.69%),and early in the morning(00:00-05:59,11.13%).The incidence time of Ovophis and Bungarus multicinctus mainly concentrated in 18:00-23:59,the time of Trimeresurus was in 06:00-11:59,and that of Naja and Ophiophagus hannah was in 12:00-17:59.Most cases of snake bite were on limbs(98.53%),and mainly on the right limbs(53.57%).The lower limbs mainly were bitten by Ovophis,while the upper limbs mainly were bitten by Naja and by Ophiophagus hannah.The local symptoms of the bite of Ovophis and Trimeresurus were similar,mainly including pain,swelling,tenderness,high temperature of skin around the wound,bleeding and exudation,etc.And the local symptoms of the bite of Naja were pain,swelling,bruising,tenderness,bleeding and exudation,red skin,etc.Numbness and mild pain were the main symptoms of the bite of Bungarus multicinctus and Bungarus fasciatus,but other local characteristics were not obvious.Conclusions The majority of venomous snake bite patients in Wuzhou City of Guangxi were middle-aged and elderly males,and the majority of venomous snakes were Ovophis,Trimeresurus,and Naja.Most venomous snake bite occurs from April to November,and the incidence time was concentrated between 12:00 and 23:59.The majority of venomous snake bite was limb bites.The local symptoms were pain,swelling,tenderness,high temperature of skin around the wound,bruising,etc.To reduce the incidence rate,disability rate and mortality of snake bite disease,a snake bite prevention system should be established,the education and publicity of snake bite prevention knowledge should be strengthened,the awareness of snake bite prevention should be improved,and clinical diagnosis and treatment should be assisted,based on the epidemiological characteristics of snake bite in Wuzhou area.