圆斑蝰蛇咬伤患者临床特征及预后影响因素

Analysis of clinical characteristics and prognostic factors of Russell′s viper bites patients

目的总结圆斑蝰蛇咬伤患者临床特征,分析影响预后的相关因素。方法对2012年1月至2021年12月广州医科大学附属第一医院急诊科收治的61例圆斑蝰蛇咬伤患者临床资料进行回顾性分析,根据抗蛇毒血清治疗方案分四组:未使用抗蛇毒血清组(A组,15例)、抗蝮蛇毒血清组(B组,25例)、抗五步蛇毒血清组(C组,7例)、抗蝮蛇毒血清+抗五步蛇毒血清联用治疗组(D组,14例),比较不同抗蛇毒血清治疗方案对靶器官保护作用及预后的影响。结果中、重度患者57例(93.4%),发生蛇毒诱发消耗性凝血病(VICC)39例(63.9%)、急性肾损伤(AKI)42例(68.9%),出院时治愈、好转47例(77.0%),死亡2例(3.3%);四组间凝血酶时间(TT)、凝血酶原时间(PT)、部分凝血活酶激活时间(APTT)改善和预后比较差异无统计学意义(P>0.05),C、D组纤维蛋白原(Fib)升高优于A、B组(P<0.05),B组肾功能改善不及A组(P<0.05),逻辑回归分析提示三种抗蛇毒血清治疗方案与预后无相关性。结论圆斑蝰蛇咬伤早期易出现VICC和AKI,导致多脏器、颅内出血及多器官功能障碍综合征;抗五步蛇毒血清对Fib减少有改善作用,而单用抗蝮蛇毒血清、抗五步蛇毒血清或两者联用对患者肾功能及预后无显著影响。

Objective To summarize the clinical characteristics of patients with Russell′s viper bites,and to analyze the related factors affecting the prognosis.Methods The clinical data of 61 patients with Russell′s viper bites who were hospitalized in the emergency department of the First Affiliated Hospital of Guangzhou Medical University from January 2012 to December 2021 were retrospectively analyzed.According to the three different antivenom treatment regimens,the patients were divided into four groups:15 cases without antivenom(group A),25 cases with anti-Agkistrodon halys antivenom(group B),7 cases with anti-Agkistrodon acutus antivenom(group C),14 cases with anti-Agkistrodon halys and anti-Agkistrodon acutus antivenom(group D),and the effects of different antivenom treatment regimens on the protection of target organ and prognosis were compared.Results There were 57 moderate and severe patients(93.4%),39 cases(63.9%)with venom-induced consumptive coagulopathy(VICC),42 cases(68.9%)with acute renal injury(AKI),and 47 cases(77.0%)were cured and improved upon discharge,2 cases(3.3%)died;there were no differences in the improvement of coagulation indexes including thrombin time(TT),prothrombin time(PT),activated partial thromboplastin time(APTT)and the prognosis of snakebite among the four groups(P>0.05),group C and D were better in terms of fibrinogen(Fib)elevation than A and B groups(P<0.05),the improvement of renal function in group B was not as good as that in group A(P<0.05).Logistic regression analysis indicated that the three different antivenom treatment regimens were not related to the prognosis.Conclusions The Chinese Russell′s viper bite is prone to VICC and AKI at the early stage,leading to multiple organ hemorrhage,intracranial hemorrhage and multiple organ dysfunction syndrome(MODS);anti-Agkistrodon acutus antivenom can improve the Fib reduction,but anti-Agkistrodon halys antivenom,anti-Agkistrodon acutus antivenom or combined treatment has no significant effect on renal function and the prognosis.