喀斯特地貌武隆地区毒蛇咬伤流行病学分析

Epidemiology of venomous snakebites in karst landform of Wulong District

目的分析喀斯特地貌武隆地区毒蛇咬伤的流行病学特点,为构建毒蛇咬伤防治体系提供重要依据。方法回顾性分析2017年1月~2021年12月我院收治的205例武隆地区毒蛇咬伤患者的临床资料,对致伤蛇种类、地理分布、受伤人群、致伤时间、就医时间以及抗蛇毒血清的使用情况、治疗时间等资料进行总结,并分析其特点。结果205例毒蛇咬伤患者中,59.0%的患者致伤蛇种不明确,其次五步蛇咬伤为15.1%,蝮蛇咬伤为11.2%,烙铁头咬伤为9.8%,竹叶青咬伤为4.9%。发生地集中在武隆的东北部(27.8%)、东南部(24.4%)、东部(13.7%),与武隆3个喀斯特片区所在方位一致。男性高于(54.1%)女性(45.9%),且以60岁以上患者居多(44.8%),其次为51~60岁患者(25.9%)。受伤原因以务农为主(59.5%),其次为居家被咬伤(17.6%),致伤部位以四肢多见。致伤月份从3~5月份出现并逐渐增长,主要集中在6~9月份(82.4%),以8月份为高峰期(22.9%),10月份逐渐减少,符合蛇类冬眠特性。本研究大多患者(66.3%)在致伤3 h内到达医院及时就医,且81.9%在3 h内就医的患者治疗7 d内出院,住院时间平均4.93 d。本研究患者使用的抗蛇毒血清种类单一(为抗五步蛇毒血清和抗蝮蛇血清),这主要受患者经济情况及致伤蛇种类不明影响结论本研究初步掌握了武隆地区毒蛇咬伤的流行病学特点:大部分患者致伤蛇类不明确,以夏季高发,且以务农者发生率高,大部分患者能及时就医和合理使用抗蛇毒血清治疗,住院时间平均4.93 d。通过了解本地区毒蛇咬伤的流行病学特点,加强针对性宣教,以提高高危人群的防护意识,提高医务人员的诊治水平,对促进本地区旅游事业发展和提高患者生活高质量具有重要意义。

Objective To analyze the epidemiological characteristics of snakebite in Wulong area of karst landscape,and to provide an important basis for constructing the prevention and control system of snakebite.Methods The clinical data of 205 patients with snakebite in Wulong area from January 2017 to December 2021 were retrospectively analyzed,and the geographical distribution of snake species and the time of injury of injured people were studied.Results Among 205 patients with snakebite,unknown snake was the main species causing injury in Wulong(59.0%),followed by Ancistrodon acutus(15.1%).The occurrence areas were concentrated in the northeast(27.8%),southeast(24.4%)and east(13.7%),which was the same as the three karst areas in Wulong.There were 111 males(54.1%)and 954 females(45.9%).The average age was 57.41 years(range,1-87 years).Most patients were older than 60 years old(44.8%),followed by 51-60 years old patients(25.9%).The main cause of injury was farming(59.5%),followed by biting at home(17.6%).Snake bites did not occur in January,February and December.Snake bites appeared from March to May and gradually increased,mainly concentrated in June to September(82.4%),with August as the peak(22.9%).It starts to decrease in October,which is in line with the hibernating characteristics of snakes.Most of the patients(66.3%)arrived at the hospital within 3 hours for timely medical treatment,and 81.9% of the patients were discharged within 7 days if they could reach the hospital within 3 hours.The averagely hospital stay was 4.93 days(166 cases,81.0%).The overall symptoms were mild,the efficacy was good,and the success rate of treatment was high.The variety of antivenoms in this area is single,and the use of antivenoms was affected by many factors,such as economy and unknown snake species,which affect the quality of treatment.Conclusion The most common venomous snake bites in Wulong area were unknown species,followed by Ancistrodon acutus.The incidence of snakebite is high in summer,male is more common,and the incidence of injury in farming is high.There is a close relationship between karst landform and snakebite in Wulong area.Timely medical treatment and rational use of antivenoms have a positive impact on treatment,and the formulation of feasible prevention and control programs can promote the development of local tourism and high quality of people’s life.