毒蛇咬伤病人的血小板聚集功能初探  

Study on Platelet Aggregation Function in Patients of Snakebite

作　　者：李其斌[1] 余奇松[1] 黄光武[1] 甘廷庆[1] 小杉忠诚[2] 

机构地区：[1]广西医科大学一附院急诊科蛇伤救治中心,广西南宁530021 [2]日本国立琉球大学医学部

出　　处：《蛇志》2005年第3期145-148,共4页Journal of Snake

摘　　要：目的为了探讨血液毒及混合毒类毒蛇咬伤病人的血小板功能情况,了解临床中毒发病机理。方法对近年来在本院急诊科确诊的五步蛇(Da.),蝮蛇(Ah.),眼镜蛇(Nn.),眼镜王蛇(Oh.),蝰蛇(Vr.),烙铁头(Tm.)和竹叶青(Ts.)等各种血液毒及混合毒类毒蛇咬伤17例病人25个血样,进行最大血小板聚集率(MAR)的检查和分析研究。结果除了Da未见MAR下降外(仅1例1个样品),其余各蛇种咬伤的样品均有下降。在获得未经治疗(抗蛇毒血清)的15个样品的检查结果中,进行统计分析,Vr、Tm以及Ah的MAR比正常人对照组(51.3±16.0)%明显下降。结论蛇毒中的血小板集聚抑制因子,可引起蛇伤患者体内血小板聚集功能下降,血小板处于无用状态,结果有些蛇伤病人DIC样综合征时出现严重出血而无明显微循环血栓形成致器官受损的临床症状。Objective In order to research on the platelet aggregation in the patients with venom poisoning after snakebite. Methods We observed the clinic symptom and measured the maximum platelet aggregation rate （MAR） in 25 samples from 17 patients envenomed by Deinagkistrodon acutus （Da. ） , Agkistrodon halys （ah. ） , Naja naja atra （Nn.）, Ophiophagus hannah （Oh.）, Vi pera russellii （Vr. ） , Trimeresurus rnucrosquamatus （Tm.） and Trimeresurus stejnegeri （Ts.） snakebite. Results The MAR in the sample of Ah, Nn, Oh, Vr, Tm and Ts snakebite were decreased expect the Da snakebite （only 1 case and 1 sample）. To statistical analysis the results of 15 samples that obtained in the patients with snakebite by Ts, Tm, Ah, Ah, Nn, Vr and Da before application of antivenom, the mean AMR values were significantly decreased in the cases who bited by Vr. , Tin. and Ah snake. Conclusions After snakbite, the platelet aggregation inhibitive factor of venoms may cause the MAR decrease. Some patients with DIC-like syndrome may present the severe bleeding but not MODS without microcirculation thrombosis because of the platelet disfunction.

关 键 词：蛇伤 蛇毒中毒 血小板聚集率 DIC样综合征 

分 类 号：R595.8[医药卫生—内科学] R364.1[医药卫生—临床医学]