Study of clinical profile and outcome of patients with snake envenomation at Bheri Hospital Nepal

R. Mandal, Nirmal Shakya, Sanket Kumar Risal, Kuldip Goit
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Abstract

BACKGROUND Snake bite is a public health problem in terai and inner terai of Nepal. It is a medical emergency leading to significant morbidity and mortality every year. This study aims to find the clinical profile and outcome of snake bite envenomation patients in Bheri Hospital Nepalgunj. METHODS This was a cross sectional, observational study from April 2021 to November 2021. Patients with history of snake bite and clinical features suggesting envenomation were enrolled in this study, their clinical data and outcome were recorded in Excel sheet and analyzed by SPSS 20. RESULTS A total of 58 cases of snake envenomation was admitted and managed, out of which 3 cases expired with case fatality of 5.17%. Krait and cobra were the common snake bites in this region. 84.48% of the snake bites occur inside houses and more than half 53.44% of the patients were bitten between 12am to 6am. The most common features of envenomation were ptosis, blurring of vision, swallowing difficulty, dysphonia, neck muscle weakness, epigastric pain and salivation. Majority of cases 96.55% was given 10 vials of Anti snake venom (ASV). Only 4 patients 6.89% needed ventilator assistance. CONCLUSION Mortality with snake bites can be minimized by strengthening the treatment centers and readily availability of ASV at such centers. Public awareness about snake bite, first aid, rapid transport to health facilities would be the key to success in reducing morbidity and mortality.  
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尼泊尔Bheri医院蛇中毒患者的临床概况和预后研究
背景:蛇咬伤是尼泊尔泰莱和内泰莱地区的一个公共卫生问题。这是一种每年导致大量发病率和死亡率的医疗紧急情况。本研究旨在了解尼泊尔百里医院毒蛇咬伤中毒病人的临床情况及转归。方法:这是一项横断面观察性研究,研究时间为2021年4月至2021年11月。本研究纳入有蛇咬伤史和提示中毒的临床特征的患者,将其临床资料及转归记录在Excel表格中,并使用SPSS 20进行分析。结果共收治蛇中毒58例,其中死亡3例,病死率5.17%。该地区最常见的蛇咬伤是水蛇和眼镜蛇。84.48%的患者发生在室内,超过一半的患者发生在凌晨12点至6点之间。中毒最常见的特征是上睑下垂、视力模糊、吞咽困难、发音困难、颈部肌肉无力、上腹痛和流涎。96.55%的病例给予10瓶抗蛇毒(ASV)。只有4例患者需要呼吸机辅助。结论加强治疗中心建设,提高治疗中心ASV的可及性,可降低蛇咬伤死亡率。公众对蛇咬伤、急救和迅速送往卫生设施的认识将是成功降低发病率和死亡率的关键。
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