| Abstract | Cilj istraživanja: Ciljevi ovog istraživanja bili su definirati klinička i epidemiološka obilježja ugriza zmija otrovnica u Splitsko-dalmatinskoj županiji, prikazati lokalne i opće komplikacije, te načine liječenja otrovanja zmijskim otrovom.
Materijali i metode: U ovom retrospektivnom, kliničko-epidemiološkom istraživanju prikazana su 93 ispitanika, liječena u Kliničkom bolničkom centru Split zbog otrovanja zmijskim otrovom. Promatrano je razdoblje od 1. siječnja 2009. godine do 31. prosinca 2020. godine, a obuhvaćeno je područje Splitsko-dalmatinske županije. Ispitanici su bili svih dobnih skupina (najmlađi 3 godine, a najstariji 88 godina).
Rezultati:. Među ispitanicima bilo je 63,4% muškaraca i 36,6% žena. Medijan životne dobi bio je 59 godina (za muškarce 57 godina, a žene 63,5 godina). Niti jedan pacijent nije smrtno stradao od posljedica otrovanja zmijskim otrovom. Najveći broj ugriza se dogodio u razdoblju od početka svibnja do kraja rujna (78,49%). Većinom su pacijenti razvili otok i/ili crvenilo na mjestu ugriza, a krvni podljev uočen je u 73,1% slučajeva. Povraćanje, proljev, povećani i bolni regionalni limfni čvorovi nisu bili rijetki. Najčešća lokalna komplikacija bila je hemoragična bula (12,9%), dok su nekroza kože i/ili mišića, „compartment“ sindrom i tromboza i/ili tromboflebitis rjeđe utvrđeni. Kirurška intervencija bila je potrebna u 16.1% ispitanika, a najčešće je to bila incizija hemoragične bule. Od općih komplikacija prema učestalosti su se pojavljivali: kljenut živca (12,9%), predšok/šok, krvarenje i poremećaj stanja svijesti, dok oštećenja jetre i bubrega nisu zabilježeni. Najčešće upotrjebljena metoda prve pomoći je bila postavljanje podveza, a imobilizacija i isisavanje otrova iz rane bili su rijetki. U terapiji su korišteni kortikosteroidi, antihistaminici, antiviperini serum, antitetanička profilaksa i antibiotici.
Zaključak: Jedini specifičan način liječenja pacijenata otrovanih zmijskim otrovom primjena je antiviperinog seruma. U ovom radu od ukupnog broja ispitanika njih 89,2% je dobilo protuotrov. Učestalost lokalnih i općih komplikacija je bila jednaka (22,6%). Povezanost između razvoja lokalnih i općih komplikacija i vremena koje je prošlo od ugriza do primjene antiviperinog seruma nije statistički značajna. |
| Abstract (english) | Objective: The aims of this study were to define clinical and epidemiological characteristics of venomous snakebites in the Split-Dalamatia Couty, to present local and general complications, and ways of envenomation treatment.
Materials and Methods: In this retrospective, clinical-epidemiological study 93 subjects, treated in the University Hospital of Split for snakebite envenomation, were presented. The period from 1st January, 2009 to 31st December, 2020 was observed, and the area of Split-Dalmatia County was covered. Subjects were of all ages (the youngest was 3 years old, and the oldest was 88 years old).
Results: Among the subjects, 63.4% were men and 36.6% were women. The median age was 59 years (57 years for men and 63.5 years for women). No patient died from snakebite envenomation. The largest number of snakebites occured in the period from early May to late September (78.49%). Most patients developed swelling and/or discoloration at the site of the bite, while haematoma was observed in 73.1% of cases. Vomiting, diarrhea, enlarged and painful regional lymph nodes were not uncommon. The most common local complication was haemorrhagic blister (12.9%), while skin and/or muscle necrosis, compartment syndrome and thrombosis/thrombophlebitis were less common. Surgical intervention was required in 16.1% of cases, and most often it was the incision of hemorrhagic blister. Of the general complications according to frequency, the following occurred: nerve paralysis (12.9%), pre-shock/shock, bleeding and central nervous system depression, while liver and kidney damage were not reported. The most commonly used method of first aid was constricting band, while immobilization and suction at the bite site were rare. Corticosteroids, antihistamines, antivenom, tetanus prophylaxis and antibiotics were used in therapy.
Conclusion: The only specific treatment for patients after venomous snakebite is the use of antivenom. In this paper, 89.2% of the total number of respondents received an antivenom. The frequency of local and general complications was equal (22.6%). The association between the development of local and general complications and the time that elapsed from the snakebite until the application of the antivenom is not statistically significant. |
