| Abstract | Cilj rada bio je utvrditi incidenciju ugriza zmija otrovnica u Splitsko-dalmatinskoj županiji, te prikazati epidemiološka obilježja, kliničku prezentaciju (uključujući lokalne i opće komplikacije), te načine liječenja otrovanja zmijskim otrovom na ovom području.
Provedeno je retrospektivno, kliničko-epidemiološko istraživanje.
Istraživanje je provedeno u Splitsko-dalmatinskoj županiji.
U ovom istraživanju prikazano je 160 djece i adolescenata otrovanih zmijskim otrovom u dobi od nula do osamnaest godina, koji su liječeni u Kliničkom bolničkom centru Split u razdoblju od 1. siječnja 1976. do 31. prosinca 2010. godine.
Prosječna godišnja incidencija ugriza otrovnica u Splitsko-dalmatinskoj županiji u dobnoj skupini od nula do osamnaest godina iznosila je 4,2/100 000, te je u dječaka bila gotovo tri puta veća nego u djevojčica. Naime, prosječna godišnja incidencija u dječaka iznosila je 5, a u djevojčica 1,7 na 100 000 djece. Smrtno je stradalo jedno dijete (0,6%). Većina ugriza dogodila se od početka svibnja do kraja kolovoza (80%). Gotovo svi bolesnici su na mjestu ugriza otrovnice imali otok i/ili crvenilo kože, a njih 97,5% i krvni podljev. Klinički su utvrđeni povećani limfni čvorovi u 48%, povraćanje u 21%, a proljev u 2,5% bolesnika. Od lokalnih komplikacija najčešće su utvrđene hemoragične bule (20%), zatim nekroze kože i mišića (4,4%), „compartment“ sindrom (3,1%), tromboze i/ili tromboflebitisi (0,6%) i infekcije (0,6%). Od općih komplikacija najčešće su bile kljenuti moždanih živaca (11,2%), zatim šok i prijeteći šok (7%), somnolencija (5%), poremećaji zgrušavanja krvi (3,1%), oštećenje bubrega (2,5%) i jetre (2%), te sopor (0,6%). Svi bolesnici primili su antiviperini serum i antitetaničku profilaksu, a velika većina još i antibiotike (95,6%), kortikosteroide (84%) i antihistaminike (71%). Kirurški se interveniralo u 24% bolesnika. Najčešća intervencija bila je incizija hemoragične bule (17%), a zatim nekrektomija (3,8%), te fasciotomija (3,1%).
Opće komplikacije najčešće su se razvile u dojenčadi i male djece u dobi do četiri godine. Ukoliko je prošlo dulje vremensko razdoblje od ugriza otrovnice do primjene antiviperinog seruma, opće komplikacije su bile češće. |
| Abstract (english) | The aim of this study was to show the incidence of venomous snake bites, epidemiological characteristics, clinical symptoms (including local and general complications) and ways of treatment.
In this retrospective study 160 patients aged 0 to eighteen years, have been shown. All patients were poisoned by snake venom, in south Croatia and treated at the Clinical hospital Split in the period from 1 January, 1976 to 31 December, 2010.
The average annual incidence of venomous snake bites at the age group 0 to eighteen years was 4.2 / 100 000. The average annual incidence at boys was 5/100 000, almost three times higher than it was at girls (1,7/100 000). Most bites occurred from early May to late August (80%). Almost all patients, at the site of the bite, developed swelling and/or redness of the skin, and 97.5% of them hematoma. Enlarged lymph nodes developed in 48% of patient, vomiting in 21% and diarrhea in 2.5% of patients. Hemorrhagic bullae (20%), followed by necrosis of the skin and muscle (4.4%), „compartment“ syndrome (3.1%), thrombosis and / or thrombophlebitis (0.6%) and infection ( 0.6%) are local complications that were usually identified. The most common general complication was the brain nerve palsy (11.2%), followed by shock and threatening shock (7%), somnolence (5%), a disorder of blood clotting factors (3.1%), renal failure (2.5% ), liver (2%) and sopor (0.6%). All patients received antivenin (100%) and tetanus prophylaxis (100%), and the vast majority of patients even antibiotics (95.6%), corticosteroids (84%) and antihistamines (71%). Surgical intervention was provided in 24% of patients. The most common intervention was incision of hemorrhagic bullae (17%), followed by removal of necrosis tissue (3.8%), and fasciotomy (3.1%).
General complicatons were more frequent at the infants and at the children up to age of four. If the time between the bite and application of antivenin was longer general complications were more frequent. |
