毒蛇咬伤致皮肤感染相关危险因素分析  

Analysis of Risk Factors Associated with Skin Infection Caused by Venomous Snakebites

作　　者：李家耀 钟武勇 罗威 廖民霞 余永志 伍颖光 彭敏汀 LI Jiayao;ZHONG Wuyong;LUO Wei;LIAO Minxia;YU Yongzhi;WU Yingguang;PENG Minting(Clinical Laboratory,Wuzhou Hospital of Traditional Chinese Medicine,Wuzhou City,Guangxi Zhuang Autonomous Region,543002,China;International Biotoxin Center,Wuzhou City,Guangxi Zhuang Autonomous Region,543002,China)

机构地区：[1]广西壮族自治区梧州市中医医院检验科,广西梧州543002 [2]国际生物毒素中心,广西梧州543002

出　　处：《蛇志》2025年第1期6-10,共5页Journal of Snake

基　　金：广西壮族自治区卫生健康委员会科研课题(项目名称:竹叶青蛇临床免疫诊断方法开发,项目编号:Z20200287);中央引导地方科技发展资金项目(项目名称:中国<广西>“东盟国际蛇伤防治研究中心”,项目编号:202201002)。

摘　　要：目的探讨毒蛇咬伤患者皮肤感染的相关危险因素。方法回顾性分析2019年9月至2020年11月在我院治疗的124例毒蛇咬伤患者的临床资料,根据是否发生皮肤感染分为未感染组(92例)和感染组(32例),采取单因素与多因素Logistic回归分析两组患者的临床资料和实验室检查结果。结果两组患者的肿胀程度、溃疡程度、伤口切开以及使用抗蛇毒血清、预防性使用抗菌药物、白细胞计数、C-反应蛋白、纤维蛋白原和D-二聚体水平比较,差异均有统计学意义(均P<0.05)。两组患者的性别、年龄、蛇咬伤部位、咬伤后救治时间、伤口处是否绑扎、蛇毒类型、临床中毒程度、入院时患者意识情况、红细胞计数、血红蛋白、血小板计数、超敏C-反应蛋白、总胆红素、谷丙转氨酶、谷草转氨酶、谷氨酰转移酶、肌酐、肌酸激酶同工酶、乳酸脱氢酶、α-羟丁酸脱氢酶、凝血酶原时间、活化部分凝血酶原时间、凝血酶时间比较,差异均无统计学意义(均P>0.05)。多因素Logistic回归分析显示,溃疡程度为Ⅱ~Ⅲ度、伤口切开是毒蛇咬伤发生皮肤感染的独立危险因素,使用抗蛇毒血清、预防性使用抗菌药物是毒蛇咬伤皮肤感染的保护因素(均P<0.05)。结论皮肤感染是毒蛇咬伤后的常见不良症状,溃疡程度为Ⅱ~Ⅲ度、伤口切开是毒蛇咬伤致皮肤感染的危险因素,使用抗蛇毒血清、预防性使用抗菌药物则是毒蛇咬伤致皮肤感染的保护因素。Objective To investigate the risk factors associated with skin infection in patients with venomous snake bites.Methods A retrospective analysis was conducted on the clinical data of 124 patients treated forvenomous snake bites in our hospital from September 2019 to November 2020.Based on the occurrence of skin infection,patients were divided into a non-infected group(92cases)and an infected group(32cases).Univariate and multivariate logistic regression analyses were performed to compare clinical data and laboratory results between the two groups.Results Statistically significant differences were observed between the two groups in terms of swelling severity,ulcer severity(gradeⅡ-Ⅲ),wound incision,use of antivenom,prophylactic antibiotic use,white blood cell count,C-reactive protein,fibrinogen,and D-dimer levels(all P<0.05).No significant differences were found in gender,age,bite location,time to treatment post-bite,wound bandaging,snake venom type,clinical toxicity severity,patient consciousness upon admission,red blood cell count,hemoglobin,platelet count,high-sensitivity C-reactive protein,total bilirubin,alanine aminotransferase,aspartate aminotransferase,gamma-glutamyl transferase,creatinine,creatine kinase isoenzyme,lactate dehydrogenase,α-hydroxybutyrate dehydrogenase,prothrombin time,activated partial thromboplastin time,or thrombin time(all P>0.05).Multivariate logistic regression analysis revealed that ulcer severity of gradeⅡ-Ⅲand wound incision were independent risk factors for skin infection following venomous snake bites,while the use of antivenom and prophylactic antibiotics served as protective factors(all P<0.05).Conclusion Skin infection is a common complication after venomous snake bites.Ulcer severity of gradeⅡ-Ⅲand wound incision are risk factors for skin infection,whereas the use of antivenom and prophylactic antibiotics.

关 键 词：皮肤感染 蛇咬伤 危险因素 

分 类 号：R646[医药卫生—外科学]