ĐẶC ĐIỂM LÂM SÀNG, CẬN LÂM SÀNG VÀ ĐÁNH GIÁ KẾT QUẢ ĐIỀU TRỊ RẮN LỤC ĐUÔI ĐỎ CẮN Ở TRẺ EM TẠI BỆNH VIỆN SẢN NHI TỈNH QUẢNG NGÃI TỪ NĂM 2020 ĐẾN NĂM 2022

Abstract

Introduction: Cases of venomous snake bites in children often have severe symptoms and a high risk of death. In which, a patient bitten by cryptelytrops albolabris is an internal emergency; clinical and paraclinical features are varied. Objective: Description of clinical, paraclinical characteristics and assessment of treatment results of pediatric patients with cryptelytrops albolabris bites at Quang Ngai Obstetrics and Pediatrics Hospital. Method:  Cross-sectional description of children hospitalized with cryptelytrops albolabris bites at Intensive Care Unit- Poison Control Department, Quang Ngai Pediatrics and Obstetrics Hospital between January 2020 and December 2022. Result: Most cases are over 6 years old, an average of 9.9 ± 3.8 years old; the ratio of male to female is 2.2/1; accidents happen any time of the year, especially from April to June with 39.6%, the most frequent time of snake bites is at 1.00 p.m to – 12. 00 p.m per day; the figure for hospitalizing before 6 hours was 79%; Most were accidentally bitten by a snake. Local symptoms with toxic hook, pain and local swelling are over 90%, hemorrhage accounts for 13.5%; bruising reaches 65.4%; bullous skin is 21%; necrosis is 3.7%; and the proportion of infection is 25.9%. Snake-bite on the leg accounts for 77.4%, of which at the foot is 70.4%. The percentage of Odontorrhagia and epistaxis is equal, by 5%; there is no gastrointestinal bleeding. Hemoglobin is normal, platelets do not decrease; leukocyte increase in a severe group; prolonged PT with 21%; 19.8% INR increase; 16% prolonged aPTT; 22.2% coagulopathy; it belongs to moderate and severe toxicity. First aid can include applying herbal medicine at 29.6%, immobilization with splints at 18.5%, 11% garrot, and wound washing by 60.5%. Using anti-snake venom (ASV) is 53.1%; among them, using ASV 2 times is 4.65%, and ASV 3 times is 2.32% in the group of assigning to use ASV. The number of vials of 4-6 ASV vials accounts for the highest rate of 34.6%. 90.7% of patients in the group are indicated for ASV infusion within 24 hours of snake bite. A hundred percent record no side effects while using ASV. 80.2% of patients need antibiotics. Among them, oral antibiotics get a high rate of 63%. Two severe cases receive plasma transfusion. The mean hospitalization is 5.38 ± 3.25 days (27-2). All are without complications and death. Conclusion: Applying herbal medicine and garrot increases severe risk; immobilization with splints and wound washing reduces the severity. ASV is most effective within the first 24 hours, especially within the first 6 hours after a snake bite. However, it can be considered for severe poisoning cases even if hospitalization is later than 24 hours. It is necessary to repeat ASV infusion when clinical and paraclinical still do not improve much.