The Clinical Features And Pre-hospital First Aid Strategies Of Patients With Cobra Bites

Objective:To summarize the characteristics of patients with cobra bite, and analyze the different pre-hospital emergency treatments effect on the prognosis of patients with cabra bite.Methods:A retrospective study was conducted in Affiliated Nanhua Hospital,Universty of South China from Jan 2013 to Jan 2015. 115 of all patients bitten by cabra which admitted into Snake Bite and Toxicosis Unit were included in the study based on inclusion criteria. Data of the patients were colleced and analzed. All patients were divided into mild, severe, and critical groups according to the degree of poisoning, and divided into binding group and non-binding group according to pre-treatment, and divided into incision group and non-incision group according to pre-treatment. There were two groups, A group(visit time < 8h) and B group(visit time≥8h), based on visit time; The elderly group(age≥60) and non-elderly group(age <60), the skin graft group and the non- graft group were classfied by age and skin graft, respectively.Results:1.The mean treatment time 17.11 hours(h), the earliest lh, the latest 168 h. 2. 114 of all patients were cured(99.13%) and one case died of multiple organ dysfunction syndrome(MODS); 56 cases underwent skin graft(48.70%). 3.Serum levels of CK, CK- MB, ALT and AST were significant different in mild, severe, and critical groups(P < 0.001). Skin graft was markerly lower in patients from mild goup(20%) than patients from severe group and critical group(93.3%)(P<0.001). 4.Skin graft rate was obviously higher in binding group(72%) than non-binding group(30.8%)(P <0. 001); serum levels of CK, WBC and scores of ulcer, swelling were obviously higher in binding group than non-binding group(P<0.05). 5. Serum levels of biochemical indices(WBC, CK, CK-MB, ALT, AST), clinical scores(ulcer score, swelling score, illness score), skin graft rate, and renal injury rate were lower in incision group than non-incision group(P<0.05). 6. Serum levels of biochemical indices(CK, CK-MB, ALT, AST), clinical scores(ulcer score, swelling score, illness score), skin graft rate, and renal injury rate were signifciant higher in group A than group B(P<0.05). 7. The serum CK-MB level and ulcer score were higher in elderly group than non-elderly group(P<0.05). 8. The serum levels of CK-MB and CK were signifciant higher in skin graft group than non-graft group(P<0.001). 9.There were positive correlation between ulcer score and serum CK or CK-MB, respectively(r=0.778,0.555); positive correlation between illness score and serum CK, CK-MB, ALT, and AST were found after correlation analysis(r=0.740,0.693,0.676, and 0.682, respectively.) 10. Multiariable Logistic regression analysis showed that: visit time more than 8 hours, local binding, severity of disease were independent risk factors of skin graft in patients with cobra bite(P < 0.01).Conclusions:1. Cobra bite can cause local tissue necrosis of patients in a shorttime, the rate of skin graft is high.2. Early incision detoxification can significantly improve prognosisof patients with cobra bite and can reduce the extent of tissuenecrosis.3. Improper binding and prolonged treatment are the independent risk factors of skin graft in patients with cobra bite.