Ulus Travma Acil Cerrahi Derg. 2010; 16(3): 210-214

Türkiye’nin güneydoðusunda Diyarbakýr ve çevresinde eriþkinlerde yýlan ýsýrýklarý

Behçet Al¹, Murat Orak², Mustafa Aldemir², Cahfer Güloðlu^2
1Gaziantep Üniversitesi Týp Fakültesi Acil Týp Anabilim Dalý, Gaziantep, Türkiye
²Dicle Üniversitesi Týp Fakültesi Acil Týp Anabilim Dalý, Diyarbakýr, Türkiye

AMAÇ
Yýlan zehiri ile zehirlenme hýzlý tedavi gerektiren bir týbbi acil durumdur. Türkiye’deki zehirli yýlan sokmalarý kýsmi doku hasarý ve sistemik semptomlara neden olabilmektedir. Vipera ammodytes türü Türkiye’nin güneydoðusunda en zehirli olanýdýr.
GEREÇ VE YÖNTEM
2003 ve 2005 yýllarý arasýnda acil servisimize baþvuran 79 V. ammodytes yýlan sokmasý olgularýnýn demografik, epidemiyolojik karakterleri, klinik belirti ve bulgularý, laboratuvar bulgularý, tedavileri ve sonuçlarý prospektif olarak incelendi, analiz edildi.
BULGULAR
En yaygýn belirti ve bulgular diþ izleri (%100), aðrý (%100), þiþkinlik (%83,54), ekimoz (%92,40), taþikardi (%24,05), baþ dönmesi ve bayýlma (%14,52), ateþ (%18,98), bölgesel lenf nodu büyümesi (%43,03), bulantý (%70,89), hipotansiyon (%21,52), kusma (%36,71) ve dispne (%3,22) idi. Ana komplikasyonlar tromboflebit, hareket kýsýtlýðý, lokal hemorajik bül oluþumu, cilt kanamasý, rabdomiyoliz, duyu azalmasý, akut böbrek yetersizliði, doku kaybý ile beraber nekrozis, parmak amputasyonu, karpal tunel sendromu ve kompartman sendromu idi.
SONUÇ
Bir V. ammodytes ýsýrýðý acil hastane bakýmý gerektiren ciddi bir durumdur. Olgularýn çoðu konservatif yöntemlerle baþarýlý bir þekilde tedavi edilebilir. Serimizde ölüm meydana gelmemiþtir.

Anahtar Kelimeler: Kompartman sendromu, rabdomiyoliz; yýlan zehiri; tromboflebit; Türk yýlanlarý; Vipera ammodytes zehirlenmesi.

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Snakebites in adults from the Diyarbakýr region in southeast Turkey

Behçet Al¹, Murat Orak², Mustafa Aldemir², Cahfer Güloðlu^2
1Departments Of Emergency Medicine, Gaziantep University Faculty Of Medicine, Gaziantep, Turkey
²Departments Of Emergency Medicine, Dicle University Faculty Of Medicine, Diyarbakýr, Turke

BACKGROUND
Snake venom poisoning is a medical emergency requiring immediate attention. Bites from poisonous Turkish snakes can lead to local tissue damage and systemic symptoms. The Vipera ammodytes species accounts for the majority of envenomation in southeast Turkey.
METHODS
The demographic and epidemiological characteristics, clinical symptoms and signs, laboratory findings, treatment, and outcome of 79 consecutive victims of V. ammodytes poisoning admitted to our hospital from 2003 to 2005 were reviewed and analyzed prospectively.
RESULTS
The most common symptoms and signs included fang marks (100%), pain (100%), swelling (83.5%), ecchymosis (92.4%), tachycardia (24.1%), fainting or dizziness (14.5%), fever (19.0%), enlargement of regional lymph nodes (43.0%), nausea (70.9%), hypotension (21.5%), vomiting (36.7%), and dyspnea (3.2%). The main complications were thrombophlebitis, reduced range of motion, local hemorrhagic blister formation, bleeding from skin, rhabdomyolysis, reduced sensation, acute renal failure, necrosis with tissue loss, digit amputation, carpal tunnel syndrome, and compartment syndrome.
CONCLUSION
A V. ammodytes bite is a potentially serious event that requires immediate hospital care. Nevertheless, the majority of victims can be treated successfully with conservative methods. No deaths occurred in our series.

Keywords: Compartment syndrome, rhabdomyolysis; snake venom; thrombophlebitis; Turkish snakes; Vipera ammodytes poisoning.

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