| ObjectiveWe collected cases of snakebites in Guangzhou and surrounding areas from 2012 to 2021,to explored the epidemiological and clinical characteristics,and provided more intuitive and reliable data for local snake bite clinical treatment,as well as more objective and detailed parameters for clinical diagnosis and treatment.MethodsA retrospective analysis was conducted of snake bite patients in the Emergency Department of the First Affiliated Hospital of Guangzhou Medical University the Snakebite Treatment Center of Guangdong Provincial from January 2012 to December 2021.The Demography information(e.g.gender,age)of patients with snake injuries,the type of snake causing the injury,the season of the bite,the time from the bite to the hospital,the use of antivenom,the severity,treatment outcome,and other clinical data were summarized and analyzed,as well as the clinical characteristics and treatment characteristics of snake injuries in special populations(children,pregnant women,and the elderly).ResultsFrom 2012 to 2021,the Guangdong Poisonous Snake Injury Treatment Center of the First Affiliated Hospital of Guangzhou Medical University treated a total of 2406 patients with snake injuries,including 609 hospitalized patients.There were a variety of injured snakes in Guangzhou and surrounding areas,with 648 cases(52.38%of the total)caused by“snake strimeresurus stejnegeri",followed by 316 cases(25.55%of the total)caused by"Naja atra(Chinese cobra)".The majority of bites were male(64.90%),while females accounted for 35.08%,with a male to female ratio of 1.85.The age of victim is 11 months to 94 years old(median age 49 years old),with the main age groups of injuries being concentrated in the 41-50 and 51-60 age groups.The bite site is mainly concentrated in the limbs(97.53%),with the lower limbs being the main site(51.25%).Snakebite incidents occur throughout the year,with frequent occurrences from July to October,with September being the peak month for snake bites.According to the 24-hour statistics of injury cases every day,snake injuries occur from 0:00 to 24:00,with peak periods mainly concentrated from 14:00 to 16:00(19.40%)and 20:00 to 22:00(15.34%).Most of the injured people were farmers,especially in farming and forestry(38.55%)and walking in the wild(26.03%).86.36%of the patients were treated within 24 hours after snake injury,and more than half(56.10%)of the patients could reach the hospital within 4 hours.Chi-square test was used to analyze the difference between the two groups of different visiting time and the severity of snake injury(p=0.000),the difference between the two groups of data was statistically significant,and different visiting time was proportional to the severity of snake injury.In terms of severity,mild to moderate to severe cases occur,with mild cases accounting for the majority(64.01%),medium cases accounting for 6.88%,and severe and critical cases accounting for 28.01%.The most common bite sites were swelling(953,87.11%)and pain(873,79.80%),and some may experience necrosis/ulcer(95,8.68%),ecchymosis(76,6.95%),numbness(60,5.48%),bleeding(54,4.36%),etc.The systemic system is mainly characterized by abnormalities in the blood system and coagulation dysfunction,accounting for about 50.00%.The manifestations of neurological involvement,such as dizziness,pain,eyelid ptosis,difficulty breathing,and changes in consciousness,account for about 7.17%.224 patients in this group had mild symptoms or "dry bites" were not treated with anti venom serum.The usage rate of antivenin in other patients was 48.75%.Among those receiving antivenin treatment patients,58.91%of them were able to use antivenin within 4 hours.The chi-square analysis of the relationship between the use of antivenom serum at different times and the severity of snake bites showed that the p=0.000,less than 0.05,and the difference between the two groups was statistically significant,indicating that the earlier the antivenom was administered,the less severe the envenomation was.Among the snake bite patients,12 pregnant women were bitten by snakes,with 91.67%of the injured snake species being“strimeresurus stejnegeri".The severity was mainly mild to medium,and local symptoms were swelling(9 cases,75.00%),pain(7,58.33%)and 6 of them had abnormal coagulation function,without serious consequences such as abortion and premature delivery.There are a total of 153 children with bite injuries,with the severity mainly being mild(52.23%)and severe(46.15%).Among the local symptoms,73.85%have pain and swelling,and the systemic symptoms are mainly blood system(56.92%).One case has multiple organ dysfunction.Elderly people over 60 years old accounted for 16.38%(394 cases),and the severity of the injury was mainly severe(53.91%).Local symptoms were mainly swelling 100 cases(78.13%)and pain 50 cases(39.06%).Systemic symptoms of hematological abnormalities 72 cases(56.25%)were common,and 4 patients experienced multiple organ failure,resulting in 1 death.The length of hospitalization for snake bite patients ranged from 1 day to 78 days,with a total average hospitalization time of 6.96 days(a median of 3 days),and a mode of 1 day.The average hospitalization cost was RMB 153000.Among them,the average hospitalization days of patients requiring only conservative medical treatment were 5.26 days,with an average cost of 134 yuan.The average hospitalization days of patients requiring surgical treatment are 29.60 days,and the average hospitalization cost for these patients is 40000 yuan.According to Spearman correlation analysis,there is a positive correlation between different visit times and hospitalization costs.ConclusionsThis study suggests that,(1)the main snake species causing snake injuries in patients are the“strimeresurus stejnegeri”and the“Naja atra”,mainly male and agricultural and forestry planting,with the age of injury mainly occurring between 41 and 60 years old.(2)May October is the season with a high incidence of snake bites,with September being the most prominent.Bites are concentrated at 14:00-16:00 and 20:00-22:00 o’clock.(3)The symptoms of snake bites are mainly mild,but children and the elderly are prone to developing into severe cases.(4)The usage rate of antivenin is relatively low,and delay use is positively correlated with the severity.(5)Surgical intervention or incision prolongs hospital stay and increases costs. |
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