尖吻蝮蛇咬伤继发脑损伤研究进展  

Research progress on secondary brain damage caused by Agkistrodon acutus bite

作　　者：杨翠 李沫 李沙沙 国富建 李兴屿 周杰 喻安永 张天喜 YANG Cui;LI Mo;LI Sha-sha;GUO Fu-jian;LI Xing-yu;ZHOU Jie;YU An-young;ZHANG Tian-xi(Department of Emergency,Affiliated Hospital of Zunyi Medical University,Zunyi City,Guizhou Province,563003,China)

机构地区：[1]遵义医科大学附属医院急诊科,贵州遵义563003

出　　处：《蛇志》2021年第4期382-386,共5页Journal of Snake

基　　金：贵州省科技计划项目(项目名称:高压氧通过NRP-1/Sema3A路径介导调节性T细胞治疗五步蛇咬伤继发性脑损伤研究,项目编号:黔科合基础-ZK[2021]一般446);国家自然科学地区科学基金项目(项目名称:VSIG4通过抑制mtROS释放在巨噬细胞M1极化及脑出血炎症损伤中的机制研究,项目编号:82060245)。

摘　　要：尖吻蝮蛇常见于武夷山和皖南山区,其毒素成分复杂、主要以血液毒素为主。尖吻蝮蛇咬伤后易出现凝血功能异常,从而引发消耗性凝血病,以及毒素破坏血脑屏障、中毒性脑细胞损伤等,导致继发性脑功能障碍,从而引起神经功能障碍甚至死亡,预后极差。临床治疗措施主要有抗蛇毒血清的应用、血液透析治疗以及联合中医治疗、高压氧辅助治疗等,以改善患者症状及预后。目前,国内外对尖吻蝮蛇咬伤继发脑损伤的相关报道均较少,且针对继发神经功能障碍疗效欠佳的相关文献罕有报道。本文就尖吻蝮蛇咬伤继发脑损伤机制及诊治的相关文献进行复习并作一综述,为临床诊疗提供参考。Agkistrodon acutus is common in Wuyi Mountain and Wannan Mountain.The toxin compositions of it are complex,mainly hematotoxin.Agkistrodon acutus is prone to abnormal blood coagulation function after bited,resulting in consumption-induced consumption coagulopathy,toxin destruction of blood brain barrier and toxic brain cell damage,which lead to secondary brain dysfunction,neurological dysfunction and even death,with poor prognosisas.Clinical treatment measures include antivenom,hemodialysis,combined Chinese medicine treatment,and hyperbaric oxygen adjuvant therapy to improve the symptoms and prognosis of patients.At present,there are few domestic and foreign related reports of brain injury secondary to Agkistrodon acutus bite,and the related curative effect for patients with secondary neurological dysfunction is poor and there are few reports in the literature.In this paper,the related literatures about brain injury mechanism,diagnosis and treatment of secondary brain injury caused by bite of Deinagkistrodon acutus are reviewed and it will provide a reference for clinical diagnosis and treatment.

关 键 词：尖吻蝮蛇 蛇咬伤 继发性脑损伤 治疗 高压氧 

分 类 号：R646[医药卫生—外科学]