糜蛋白酶注射液局部封闭治疗中华眼镜蛇咬伤中毒的合理性探讨  

The rational approach of block treatment with chymotrypsin injection for Chinese cobra bites

作　　者：黄周[1] 王威[1] 李恬 黄东凌 李俊 王璠 

机构地区：[1]广西医科大学第一附属医院急诊科,广西南宁530021 [2]广西医科大学研究生学院

出　　处：《中国急救医学》2017年第11期992-995,I0003,共5页Chinese Journal of Critical Care Medicine

基　　金：国家自然科学基金课题（81560318）;广西科技厅科技攻关项目[桂科攻（159812-28）];广西高校科学技术研究重点项目（KY2015ZD029）;广西医疗卫生适宜技术开发与推广应用项目（S2017021）;广西急诊与医学救援人才小高地课题（GXJZ201409）;广西教育厅自筹课题（LX2014073）

摘　　要：目的探讨中华眼镜蛇咬伤后使用糜蛋白酶注射液局部封闭治疗的合理性。方法①将不同浓度的糜蛋白酶与中华眼镜蛇蛇毒混合水浴，待反应完全后，使用双缩脲法测定蛇毒的残余量；②将小鼠随机分为八组，分别为造模实验组（灭菌用水组和眼镜蛇毒蛇组）、模拟局部封闭实验组（对照组、糜蛋白酶局部封闭后30min组和60rain组）、不同浓度糜蛋白对注射部位的影响实验组群（21U／mL、40U／mL和400U／mL），比较各组皮下出血的情况；③按比例将推荐糜蛋白酶用量模拟局部封闭治疗，与同剂量的眼镜蛇毒比较对小鼠死亡率的影响。结果①体外实验发现，不同浓度糜蛋白酶与眼镜蛇毒充分反应后，吸光度改变与所添加的糜蛋白酶剂量有关，反应最终平衡点不一致；②糜蛋白酶局部封闭注射30min和60min时蛇毒所致的出血面积分别为（3．05±0．12）cm^2和（3．38±0．10）cm^2，均小于空白对照组的（4．04±0．12）cm^2（均P〈0．05）；③糜蛋白酶可直接导致正常组织出血损伤，出血面积与所用糜蛋白酶剂量呈正相关（R=0．966，P〈0．01）；④按人体推荐比例糜蛋白酶用量模拟局部封闭治疗眼镜蛇中毒的小鼠，实验组与对照组的死亡率分别为44．0％和52．0％，两组比较差异无统计学意义（P〉0．05）。结论糜蛋白酶注射液不能有效灭活中华眼镜蛇毒，而且存在增加局部出血、坏死的风险，尚需进一步的临床研究及更多的循证医学佐证材料证实中华眼镜蛇咬伤后使用糜蛋白酶注射液进行局部封闭治疗的合理性。Objective To approach the rationality of block treatment with chymotrypsin for Chinese cobra bites. Methods Mixed Chinese cobra venom with different concentrations of chymotrypsin, and used biuret reaction to measure the remnant venom. Rats were randomly divided into 8 groups, which were respectively in molding groups （injected by sterile water or Chinese Cobra venom）, block treatment groups（ included match groups and groups of block treatment with chymotrypsin after 30 min or 60 min） ＆ groups of the influence by injected in different concentrations of chymotrypsin （21 U/mL, 40 U/mL or 400 U/mL）. The area of subcutaneous hemorrhage was recorded and analyzed. The mortality comparison was carried on between the experimental groups （block treatment） and the control group（ Chinese cobra venom injection）. Results In vitro experiment, there was correlation between the extinction and the chymotrypsin dosage with different balance endpoint. The subcutaneous hemorrhage areas were respectively （3.05 ±0. 12）cm^2 and （3.38 ±0.10） cm^2 30 min and 60 min after block treatment, both of them were smaller than （4.04 ± 0.12） cm^2 of blank control group （P 〈 0.05 for both）. Chymotrypsin could directly result in subcutaneous hemorrhage, and the area had a positive correlation associated with the concentration of chymotrypsin （ R = 0. 966, P 〈 0.01 ）. The mortality in the block treatment group and control group respectively were 44.0% and 52.0%, but the difference showed no statistical significance （P 〉 0.05 ）. Conclusion The dosage of chymotrypsin recommended by clinic in block treatment after Chinese cobra bites does not reach the mark of inactivating the Chinese cobra venom; furthermore it increases the risk of subcutaneous hemorrhage. The rationality of chymotrypsin for the treatment of Chinese cobra bites needs to be supported by further clinical investigations or evidence - based medicine.

关 键 词：中华眼镜蛇 中毒 糜蛋白酶 局部封闭治疗 合理性 

分 类 号：R996.3[医药卫生—毒理学]