Research Of The Impacts Of Agkistrodon Halys Bites On Organ And Coagulation Dysfunction In Northern China

ObjectiveAgkistrodon Halys is the major snake species in northern China, and most of themare severe venomous that can cause signs of organ damage, coagulopathy, DIC-likesyndrome. Annual admission of snake bite cases from Beijing and the surrounding areasin our department is over two hundred cases, and we have accumulated abundance oftreatment experience and clinical data. In this study, we proceeded retrospectiveanalysis of Agkistrodon Halys bite cases and analyzed the impacts of Agkistrodon Halysbites on organ and coagulation dysfunction and DIC-like syndrome in northern China,in order to guide the appropriate clinical treatment and observation.BackgroundThere are some reports of all kinds of snake bites in our country. And the contentsrelate with organ damage, coagulation dysfunction, DIC-like syndrome and so on.However, there are less reports concerning analysis of a region or specific snake speciessamples injury. Our department is the only scale units of snake bites in Beijing and thesurrounding, and we have accumulated abundance of experience of treatment andclinical data over these years. This study is carried out as a retrospective analysis, andelucidates organ damage and coagulation dysfunction induced by Agkistrodon Halysbites in northern China more comprehensively.Method1Case collection: Patients with Agkistrodon Halys bite admitted from June2008toSeptember2011in our Department were included, according to the clinicalclassification criteria of Snakebite care group, Critical Care Committee of TraditionalChinese Medical Society. Patients with more than severe degree were selected and theirorgan damage and coagulation dysfunction were analyzed.2Research methods: A total of128cases were screene. The blood was taken prior touse of antivenom, denoted by0days. And then took blood several times during thetreatment for FBC, coagulation test, biochemical marks, urine routine, stool routine andoccult blood test. For the convenience of representation,1to2days of blood collectionrecorded the early,3to4days of blood recorded the middle,5days and after recorded as late.20cases of the healthy adults as normal control group, indicators of whether thedifference between the above two groups were compared by Student’s t test, whileP<0.05indicated significant difference. Expression changes of indicators for bloodclotting time curve; for DIC-like syndrome case, example to the list of the actual data.ResultAgkistrodon Halys bite in northern China can cause local swelling, subcutaneoushemorrhage, local necrosis and so on, while the wound healing was general good, rareinfected. The neurotoxicity performance is minor. Some patients complained thediscomfort of chest tightness, palpitation, but no obvious ECG abnormality. Apparentinflammation occurred within24h, WBC significantly increased, persistence for2to4days, PLT declined in10.2%of patients, most returned to normal within5days;11.7%of patients with abnormal liver function, persistence for5to6days;5.5%of patientswith mild renal abnormalities, about2to4days can restored;21.9%of patients withabnormal cardiac enzymes, persistence for6days or longer; MODS rate is about0.8%.About13%of patients with mild abnormal urine test; rare gastrointestinal bleeding.Coagulation dysfunction can occur within24h, generally during24h to72h, persistencefor2to7days. Presented with Fg decreasing，PT, TT extend and APTT did not changesignificantly, DIC-like syndrome happened in9.4%of patients. D-Dimer in somepatients with normal coagulation also can increase. Overall efficiency was91.4%, curerate was60.9%, no therapy situation, intracranial hemorrhage, internal bleeding andother complications.7.8%of the incidence of all kinds of minor sequelae in One-monthFollow-up after discharge, no severe physical disabilities and other sequelae.ConclusionAgkistrodon Halys bite in northern China mainly induces damages of thecoagulation system, myocardium and liver functions, while more severe cases can occurwith MODS and DIC-like syndrome, showing bleeding tendency, severe localsymptoms and subcutaneous hemorrhage in most cases. Through timely and reasonabletreatment, the general treatment efficiency is91.4%and the cure rate is60.9%, withoutconsequences, and intracranial hemorrhage or organ bleeding can be avoided.