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題名 | Influential Factors Affecting Prognosis of Snakebite Patients Management: Kaohsiung Chang Gung Memorial Hospital Experience=影響毒蛇咬傷病人預後的因素:高雄長庚醫院的經驗 |
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作者 | 廖為博; 李啟偉; 蔡彥碩; 劉博銘; 鍾昆融; Liao, Wei-ber; Lee, Chi-wei; Tsai, Yen-shuo; Liu, Ber-ming; Chung, Kun-jung; |
期刊 | 長庚醫學 |
出版日期 | 20001000 |
卷期 | 23:10 2000.10[民89.10] |
頁次 | 頁577-583 |
分類號 | 418.8、418.8 |
語文 | eng |
關鍵詞 | 毒蛇咬傷; 壞死性筋膜炎; 間室症候群; 急性腎衰竭; 急性呼吸衰竭; Poisonous snakebites; Necrotizing fascitis; Compartment syndrome; Acute renal failure; Acute respiratory failure; |
英文摘要 | Background. The objective of this study was to determine the most influential factors affecting the prognosis of snakebite patients in Kaohsiung Chang Gung Memorial Hospital. Methods. A thorough review of the medical records of poisonous snakebite from June 1986 to November 1999 was carried out in this retrospective study. Results. Of the identified snakes in 39 bite victims, 70% of these cases were hemorrhagic type: Trimeresurus stejnegeri 20/27, T. mucrosquamatus 6/27, and Agkistrodon acutus 1/27; 28% were neurotoxic type: Naja naja atra 6/11 and Bungarus multicinctus 5/11; and 2% was mixed type: Vipera russelli formosensis 1/39. Three of four acute renal failure victims were bitten by T.mucrosquamatus. Two of the 5 victims bitten by B. multicinctus required endotracheal intubation to maintain their respiration. Five patients received skin grafting, 3 of whom were bitten by Naja naja atra. Most of our patients (55%) received only a single dose of antivenin, and 83% (29/35) of the antivenin was given within 6 hours after the bite; the antivenin infusion was finished in less than 2 hours in most cases (33/36). Conclusion. Bites from Trimeresurus stejnegeri are the most common poisonous snakebite recorded in our emergency department. T. mucrosquamatus is prominent in causing bleeding tendency and acute renal failure. Bungarus multicinctus is more prominent than Naja naja atra in causing acute respiratory failure. The dosage of antivenin used to treat patient bitten by cobra was less than that recommended by the poison control center, and the complication of skin necrosis requiring skin grafting was more severe than that of the other species. |
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