北方地区蝮蛇咬伤中毒早期对凝血系统的影响研究  

The influence to coagulation in patients bitten by agkistrodon halys in north China

作　　者：张建波[1] 闫乐媛[1] 苏琴[1] 张宪[1] 党伟[1] 刘贵福 赵晓东[1] 

机构地区：[1]解放军总医院第一附属医院急救部 [2]北京军区66018部队门诊部

出　　处：《临床急诊杂志》2012年第5期349-351,共3页Journal of Clinical Emergency

基　　金：解放军总医院科技创新苗圃基金(No:12KMM49);解放军总医院第一附属医院急救部(北京;100048)

摘　　要：目的:研究北方地区蝮蛇咬伤中毒早期对凝血系统的影响。方法:对我科2009-6-2011-06接诊的38例北方地区蝮蛇咬伤后24h之内患者的血小板计数(PLT)及凝血系统指标D-二聚体(D-Dimer)、血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血浆纤维蛋白原(Fg)及凝血酶时间(TT)作一回顾性分析,并与健康对照组共20例进行相应指标的比较。结果:蝮蛇咬伤组中,5例患者出现PLT减少,与对照组的差异无统计学意义,PT延长8例,TT延长11例,D-D升高21例,与对照组有统计学差异。而APTT和Fg均正常,与对照组的差异无统计学意义。结论:北方地区蝮蛇咬伤中毒早期在一定程度上影响患者凝血功能,但大多数患者不影响PLT计数;有纤溶增强表现,但较少造成严重脱纤维蛋白血症,较少引起DIC或DIC样综合征,需要继续观察及复查。Objective： To study the early influence to coagulation in patients bitten by Agkistrodon in north China. Method：The changes of platelet （PLT）, plasma D-Dimer （D-D）, Prothrombin time （PT）, activated partial thromboplastin time （APTT）, fibrinogen （Fg） and thrombin time （TT） were tested in 38 patients bitten by Agkistrodon and admitted into our department within 24 hours from June 2009 to June 2011 before any treatment. The same tests were tested in 20 normal controls. Result：In patients bitten by Agkistrodon, significant decrease of PLT was found in 5 patients but it showed no significant difference as compared with normal control. Elongated PT was found in 8 patients, elongated TT was found in 11 patients, increased D-D was found in 21 patients, and all of them showed significant difference with normal control. However, the levels of APTT and Fg were normal and showed no significant difference with normal control. Conclusion： Coagulation function in patients bitten by Agkistrodon in north China is affected at a certain degree during the early phase after bite poisoning, but PLT counts are not affected in the majority of patients. Although enhanced fibrinolysis is observed, it rarely leads to se- vere hypofibrinemia, DIC or DIC--like syndrome. The patients should be observed and the tests should be per- formed continuously.

关 键 词：D-二聚体 凝血 蝮蛇 弥漫性血管内凝血 DIC样综合征 

分 类 号：R554[医药卫生—血液循环系统疾病]