覆盖式负压封闭引流技术运用于广西竹叶青属毒蛇咬伤的临床研究  

Clinical study on the application of covered vacuum sealing drainage technology to the bite of venomous snakes of Trimeresurus stejnegeri in Guangxi

作　　者：罗毅[1,3] 张剑锋 翟崇宇[1] 吴雪 王琦 黄国亮 Luo Yi;Zhang Jianfeng;Zhai Chongyu;Wu Xue;Wang Qi;Huang Guoliang(Department of Emergency,Liuzhou People's Hospital/Snake Injury Treatment Base in Central and Northern Guangxi,Liuzhou 545006,Guangxi Zhuang Autonomous Region,China;Department of Emergency,the Second Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi Zhuang Autonomous Region,China;Department of Emergency,Liuzhou Traditional Chinese Medicine Hospital/Liuzhou Integrated Chinese and Western Medicine Snake Injury Treatment Center,Liuzhou 545001,Guangxi Zhuang Autonomous Region,China;Department of Emergency,the 910th Hospital,Quanzhou 362000,Fujian,China)

机构地区：[1]柳州市人民医院急诊科/桂中桂北蛇伤救治基地,广西壮族自治区柳州545006 [2]广西医科大学第二附属医院急诊科,南宁530021 [3]柳州市中医医院急诊科/柳州市中西医结合蛇伤救治中心,广西壮族自治区柳州545001 [4]联勤保障部队解放军第910医院急诊科,福建泉州362000

出　　处：《中华危重病急救医学》2020年第10期1241-1246,共6页Chinese Critical Care Medicine

基　　金：广西壮族自治区卫生健康委青年基金(Z20200021);广西壮族自治区柳州市科研与技术开发计划项目(2017BH20302)。

摘　　要：目的自行拟定竹叶青属毒蛇咬伤诊断标准,并探讨覆盖式负压封闭引流(VSD)技术用于竹叶青属毒蛇咬伤的临床治疗效果及作用机制。方法参照《中国蛇伤急救学》《中国蛇类》中有关内容制定广西竹叶青属毒蛇咬伤诊断标准:①肇事蛇为广西竹叶青属毒蛇;②患者所述蛇的外观形态基本符合广西竹叶青属毒蛇特征;③具备血液毒临床表现,即局部肿胀、伤口剧烈疼痛、部分患者出现皮下瘀斑。具备①或同时具备②和③即可诊断。选择2016年1月至2020年1月桂中桂北蛇伤救治基地/柳州市中西医结合蛇伤救治中心收治的广西竹叶青属毒蛇咬伤患者作为观察对象。将患者分为普通治疗组和覆盖式VSD技术组,每组60例。普通治疗组给予抗蛇毒血清、抗破伤风、伤口周边局封、抗炎、硫酸镁纱布外敷患肢、对症支持治疗等处理;覆盖式VSD技术组在普通治疗组基础上运用覆盖式VSD技术。两组从入院治疗次日开始计算周期,治疗周期均为7 d。在治疗周期中,每日08:00取血后采用全自动血细胞分析仪检测红细胞计数(RBC)和血红蛋白(Hb),全自动血凝分析仪检测凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib),并记录患肢肿胀程度及皮下瘀斑出现情况。结果在治疗周期不同时间点,覆盖式VSD技术组与普通治疗组PT、APTT、Fib动态变化趋势差异均有统计学意义,两组Fib于第1~4天均有下降,第5天开始逐步回升,第4天覆盖式VSD技术组Fib最低值高于普通治疗组(g/L:0.70±0.03比0.41±0.01,P<0.05);两组PT在治疗周期前中期均有上升,后期回落,第5天覆盖式VSD技术组PT峰值明显低于普通治疗组(s:25.2±0.1比35.4±0.2,P<0.05),且第7天覆盖式VSD技术组PT恢复至正常范围,普通治疗组仍异常;两组APTT在治疗周期一开始均增高并逐渐回落,第3天覆盖式VSD技术组APTT峰值低于普通治疗组(s:47.3±0.1比55.7±0.2,PObjective To established the diagnostic criteria for venomous snakebite of Trimeresurus stejnegeri in Guangxi by ourselves,and explore the clinical effect and mechanism of covered vacuum sealing drainage(VSD)in the treatment for venomous snakebite of Trimeresurus stejnegeri in Guangxi.Methods According to the Chinese emergency medicine for snakebite and the Chinese snake,the diagnostic criteria for venomous snakebite of Trimeresurus stejnegeri in Guangxi were formulated:①the responsible venomous snake was identified as Trimeresurus stejnegeri in Guangxi;②the appearance and morphology of the venomous snake described by the patient basically conformed to the characteristics of Trimeresurus stejnegeri in Guangxi;③clinical manifestations of hematotoxin included local swelling,severe wound pain,and subcutaneous ecchymosis in some patients;having①or both②and③could be diagnosed.The patients with venomous snakebite of Trimeresurus stejnegeri in Guangxi admitted to Snake Injury Treatment Base in Central and Northern Guangxi/Liuzhou Integrated Chinese and Western Medicine Snake Injury Treatment Center from January 2016 to January 2020 were enrolled.The patients were divided into the general treatment group and the covered VSD technology group,with 60 patients in each group.The general treatment group was treated with antivenom,anti-tetanus,closed injection around the wound,anti-inflammatory,magnesium sulfate gauze applied on the affected limb,symptomatic support treatment.The covered VSD technique was used in the covered VSD technology group based on the treatment options of the general treatment group.Treatment cycle of both groups were calculated from the next day of admission and lasted for 7 days.In the treatment cycle,blood was collected at 08:00 every day.The red blood cell count(RBC)and hemoglobin(Hb)were detected by automatic blood cell analyzer.The prothrombin time(PT),activated partial thromboplastin time(APTT)and fibrinogen(Fib)were detected by automatic blood coagulation analyzer,and the affected li

关 键 词：竹叶青 蛇咬伤 负压封闭引流 凝血功能 

分 类 号：R646[医药卫生—外科学]