Epidemiological investigation and follow-up analysis of snakebites in Hubei province
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摘要: 目的 了解湖北地区毒蛇咬伤流行病学特征及蛇伤患者出院后恢复情况，为本地区的蛇伤救治策略提供依据。方法 统计我院2017—2021年收治的2178例毒蛇咬伤患者的临床资料，回顾性分析年就诊量、性别年龄、地区分布、就诊时间、受伤时间、蛇种分布、费别费用、抗蛇毒血清剂量及住院相关指标统计，并电话随访573例出院患者，统计指标包括是否再次就医、复查检验指标、伤口愈合时间、肢体消肿时间及并发症。结果 湖北地区及周边蛇伤事件主要发生在4—10月份，最常见的为蝮蛇咬伤，其次为不明毒蛇类咬伤; 昂贵的抗蛇毒血清费用是就诊费用高的主要原因，这对蛇伤患者造成了沉重的经济压力。出院后常见的并发症有血清病(12.04%)、伤口不愈合(8.20%)和肢体疼痛(9.25%)。结论 了解本地区的毒蛇伤流行病学特点及蛇伤患者出院后恢复情况，能够制定符合本地区的蛇伤救治策略。Abstract: Objective To investigate the epidemiological characteristics of snakebites in Hubei province and the recovery of snake patients after discharge, so as to provide basis for the treatment strategy of snakebite in this area.Methods The clinical data of 2178 snakebites in our hospital from 2017 to 2021 were recruited. Annual visits, sex and age, regional distribution, visit time, injury time, snake species distribution, fees and antivenom dosage were retrospectively analyzed. 573 discharged patients were followed by telephone. Statistical indicators included whether to seek medical treatment again, reexamination of blood tests, wound healing time, limb swelling reduction time and complications.Results Snakebites in Hubei and its surrounding areas mainly occurred from April to October, pit viper was the cause of most common snakebites, and the second was unknown poisonous snake; The high cost of antivenom, which has caused great economic pressure on patients, was the main reason for the expenses of medical treatments. The common complications after discharge were serum disease(12.04%), wound nonhealing(8.2%) and limb pain(9.25%).Conclusion To investigate the epidemiological characteristics of ophidic accidents and the recovery of snake venomoning after discharge in this area, we can formulate the treatment strategy of snakbites.
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Key words:
- snakebites /
- ophidic accidents /
- epidemiology /
- follow-up
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表 1 湖北省及周边毒蛇咬伤分布
例 年份 武汉 黄冈 黄石 咸宁 孝感 鄂州 随州 仙桃 荆门 荆州 潜江 恩施 天门 省外 2017 82 59 26 46 25 41 24 17 8 12 5 1 4 102 2018 94 82 24 55 19 35 18 21 21 13 14 3 1 112 2019 82 58 13 50 33 46 24 25 20 9 12 5 3 80 2020 95 45 34 57 36 29 30 13 8 3 3 0 2 28 2021 92 52 36 41 26 18 27 8 5 4 5 1 1 55 合计 445 296 133 139 139 169 123 84 62 41 39 10 11 377 
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表 2 武汉市各区毒蛇咬伤分布
年份 江夏 新洲 洪山 黄陂 汉阳 蔡甸 青山 东西湖 武昌 硚口 江岸 汉南 江汉 2017 22 12 3 9 12 6 5 2 5 2 1 2 1 2018 27 9 4 4 8 7 9 8 4 6 2 4 2 2019 27 5 8 7 6 4 3 3 4 4 4 0 3 2020 31 10 8 7 4 7 4 6 4 2 0 7 5 2021 24 18 15 6 8 4 6 6 3 2 0 0 0 合计 131 54 38 33 38 28 27 25 20 16 7 13 11
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表 3 2017—2021年住院患者相关指标统计
例(%) 年份 住院人数 ICU人数 机械通气 CRRT MODS 肝损伤 伤口坏死 2017 102(22.60) 37(8.20) 11(2.43) 32(7.08) 9(1.99) 4(0.89) 5(1.11) 2018 77(15.10) 34(6.64) 21(4.10) 15(2.93) 5(0.97) 5(0.97) 32(6.25) 2019 86(18.70) 19(4.13) 10(2.17) 17(3.70) 4(0.87) 6(1.30) 12(2.61) 2020 53(13.84) 11(2.87) 5(1.31) 21(5.48) 11(2.87) 2(0.52) 17(4.44) 2021 76(20.49) 31(8.36) 17(4.58) 31(8.36) 17(4.58) 7(1.89) 23(6.20)
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表 4 出院患者3个月后电话随访指标统计
随访指标 例(%) 再次就医 327(57.07) 复查检验指标 216(37.7) 伤口愈合时间 < 1周 75(13.09) 1~2周 331(57.77) 2~4周 128(22.34) >1个月 39(6.81) 肢体消肿时间 < 1周 96(16.75) 1~2周 152(26.53) 2~4周 79(13.79) >1个月 64(11.17) 并发症 血清病 69(12.04) AKI 23(4.01) 伤口不愈合 47(8.20) 肢体疼痛 53(9.25) 心肌炎 9(1.57) 慢性肾损伤 12(2.09) 肝损伤 2(0.35) 消耗性凝血病 4(0.70) 高血压 22(3.84)
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