Analysis On The Clinical Characteristics Of Bite Of Agkistrodon Acutus And The Risk Of Limb Ulcer

Objective: 1.Analyse the clinical characteristics of biting by Agkistrodon acutus.2.Analyse the risk factors of limb tissue ulcer caused by Agkistrodon acutus,and explore the prevention and treatment strategies of ulcer caused by it.Methods: The clinical data of 84 patients with bite of Agkistrodon acutus treated according to the inclusion and exclusion criteria were collected from November 2013 to November 2019 in the Department of Snake Injury,Nanhua Hospital Affiliated to Nanhua University for retrospective analysis: 84 patients with snake bite During hospitalization,the Department of Injury and Toxicology was treated according to a unified routine system and evaluated the ulcer necrosis of the affected limbs and wounds,It was divided into two major groups: the non-ulcer group and the ulcer group.Both groups followed the standard treatment plan of Agkistrodon acutus,using sufficient serum to activelytreat symptomatically such as anti-allergy,anti-inflammatory,swelling,diuresis,liver protection,and dressing change.84 patients were further subdivided according to factors that may affect wound ulcers:(1)divided into male group and female group according to gender;(2)divided into age≥60 years old group and age <60 years old group according to age;(3)according to sharp snout viper After the bite,the hospital visit time was divided into groups <8h,≥8h;(4)According to the site of the bite,it was divided into the upper extremity group and the lower extremity group;Whether to perform wound incision after injury is divided into incision group and non-incision group;(7)Due to the small number of critically ill patients,according to the Chinese and Western Medicine Scoring Standards for Snake Injury Clinical Condition Classification formulated by the fourth international snake injury conference,the patients were divided into mild disease group and heavy-critical disease group.The case data of patients with Agkistrodon acutus bite was complete,and the clinical data of all patients were aggregated into Excel.After collecting and summarizing the data,a complete SPSS database was established,and IBM SPSS 22.0software was used for data analysis.Results:Among the 84 patients with Agkistrodon acutus bite,43 patients were non-elderly(51.2%),71 patients were male(84.5%),and 46patients(54.8%)were seen within 8 hours after the bite.59 patients(79.2%),49 patients(58.3%)bitten lower limbs,36 patients(42.9%)whounderwent pre-hospital ligation after biting,and 34 patients(40.5)who underwent incision after biting %),33 patients(39.2%)without ulcers,44patients(52.4%)with mild swollen limbs;After biting of Agkistrodon acutus,various local and systemic symptoms could occur,and in severe cases,it could be fatal;Differences in PLT,RBC,NEU,PT,INR,PT%,APTT,TT,FIB,IBIL,CREA,CRP,LACT,D-D before and after routine treatment among the laboratory examination indicators of Agkistrodon acutus were statistically significant(p <0.05);PLT,WBC,PT,APTT,TT,FIB,BUN,MB,D-D in admission test results and serum dosage of heavy and critically ill patients after bite of Agkistrodon acutus andare were different from the light group,(p <0.05);The ulcer group’s serum dosage and PLT,HB,WBC,HCT,MB,LACT in the results of laboratory tests at admission were significantly different from the non-ulcer group(p <0.05);Compared with patients with moderate and severe swelling,the difference in serum dose and PLT,WBC,NEU,PT,TT,FIB,CREA,CRP in patients with mild swelling after Agkistrodon biting is statistically significant(p<0.05);There were statistically significant differences in the clinical condition score,swelling score,ulcer score and PLT,APTT,LACT of laboratory test results prehospital ligation after Agkistrodon pit viper bite between and those who did not undergo ligation(p <0.05);After the venomous snake viper was bitten and treated with incision,There were statistically significant differences between the group’s disease score,swelling score,ulcer score,serum dosage,and HBs,HCT,CRP of laboratory test results after admission and those without incision(p <0.05);Comparison of HB,WBC,CREA,CRP,LACT and medical condition score,swelling score,ulcer score of patients who visited the clinic within 8hours after biting of Agkistrodon acutus and patients who visited for more than 8 hours,differences were statistically significant(p <0.05).Taking ulcers as the dependent variable,the relevant factors affecting the rate of ulcers(time to visit after bite,whether to ligate before hospital,whether to perform wound incision,type of poisoning,type of swelling,serum dosage,PLT,HB WBC,HCT,MB and LACT)were used as independent variables to perform stepwise binary logistic regression analysis,and finally screened out the independent risk factors that affected the ulcer rate of the affected limbs: the time of treatment,whether it was ligated before the hospital,whether the wound was cut,and the dose of serum.Conclusions:1.The platelet count of patients with bite of Agkistrodon acutus sharply decreased,and the coagulation function index quickly became abnormal.It is an observation index used to guide the use of anti-venom serum or measure the insufficient amount of serum.2.Delays in treatment and improper ligation before hospitalization lead to the occurrence of limb ulcers after bite of Agkistrodon acutus,which is an independent risk factor for necrosis oflimb ulcers.3.Reasonable wound incision can improve the prognosis of wound ulcer necrosis,which is a protective factor for limb ulcers.