一次性覆盖式负压封闭引流技术在福建竹叶青属毒蛇咬伤救治中的应用  

Application of single time covered vacuum sealing drainage technology on snakebite of Trimeresurus stejnegeri in Fujian

作　　者：黄国亮 覃晓波 吴雪 陈冰冰 陈黎明 罗毅 HUANG Guo-liang;QIN Xiao-bo;WU Xue;CHEN Bing-bing;CHEN Li-ming;LUO Yi(Department of Emergency,Quanzhou Women’s and Children’s Hospital,Quanzhou City,Fujian Province,362000,China;Department of Emergency,Liuzhou Traditional Chinese Medicine Hospital/Liuzhou Integrated Chinese and Western Medicine Snake Injury Treatment Center,Liuzhou City,Guangxi Zhuang Autonomous Region,545001,China;Department of Emergency,the 910th Hospital,Quanzhou City,Fujian Province,350000,China)

机构地区：[1]泉州市妇幼保健院/儿童医院急诊科,福建泉州362000 [2]柳州市中医医院急诊科/柳州市中西医结合蛇伤救治中心,广西柳州545001 [3]联勤保障部队第910医院急诊科,福建泉州350000

出　　处：《蛇志》2022年第2期145-149,共5页Journal of Snake

基　　金：柳州市科学研究与技术开发计划项目课题(项目名称:桂中蛇伤图鉴与诊疗指南研究及推广应用;项目编号:2017BH20302);广西壮族自治区卫生健康委员会科研课题(项目名称:覆盖式VSD技术运用于广西竹叶青属毒蛇咬伤的临床研究;项目编号:Z20200021);福建省泉州市科技计划项目(项目名称:覆盖式VSD技术运用于福建竹叶青属毒蛇咬伤的临床研究;项目编号:2020N055s);广西壮族自治区卫生健康委员会中医药管理局科研课题(项目名称:犀角地黄汤联合VSD技术运用于“广西竹叶青属毒蛇咬伤”的临床研究;项目编号:GZZC2020430)。

摘　　要：目的探讨一次性覆盖式负压封闭引流技术(VSD)在福建竹叶青属毒蛇咬伤患者救治中的应用效果。方法选取2018年6月~2020年9月三家医院收治的福建竹叶青蛇咬伤患者120例作为研究对象,随机分为VSD组和对照组,每组60例。在常规治疗基础上,对照组采用50%的硫酸镁纱布湿敷患肢治疗,VSD组采用一次性覆盖式负压引流敷料治疗,比较两组患者的患肢肿胀、疼痛情况以及PT、APTT、Fib和D-D等血液相关指标。结果两组患者在T_(0)时肿胀程度比较,差异无统计学意义(P>0.05);但在T_(1)、T_(2)和T_(3)时比较,差异具有统计学意义(均P<0.05)。在T_(1)、T_(2)和T_(3)时,VSD组双侧肢体周径差值和VAS评分均显著低于对照组,差异均有统计学意义(均P<0.05)。两组患者治疗过程中,PT、APTT和D-D均呈现出先升高后降低的趋势,Fib呈现出先降低后升高的趋势;两组各指标比较,VSD组在T_(1)、T_(2)和T_(3)时的PT、APTT均较对照组降低,Fib较对照组高,而在T_(2)和T_(3)时D-D较对照组低,差异均有统计学意义(均P<0.05)。结论采用一次性覆盖式负压封闭引流技术治疗福建竹叶青属蛇咬伤患者时,能够有效改善患肢肿胀程度,减轻疼痛,促进凝血功能恢复,具有较好的临床疗效。Objective To explore the effect of vacuum sealing drainage(VSD)on the bite of venomous snakes of Trimeresurus stejnegeri in Fujian.Methods The patients admitted to three hospitals from June 2018 to September 2020 were randomly divided into VSD group and control group.On the basis of conventional treatment,the control group was treated with 50%magnesium sulfate gauze wet dressing on the affected limb,while the VSD group was treated with single time covered vacuum sealing drainage technology.The swelling and pain of the affected limb of the two groups were compared,as well as blood-related indicators such as PT,APTT,Fib and D-D.120 patients were finally included,60 in each group,and the general data of patients in the two groups were comparable.Results There was no statistically significant difference in the degree of swelling between the two groups at T_(0) time(P>0.05),but there was statistically significant difference at T_(1),T_(2)and T_(3)times(P<0.05).The peripheral diametral difference and VAS score of the VSD group were significantly lower than those of the control group at T_(1),T_(2)and T_(3)times(P<0.05 for each).During the treatment,PT,APTT and D-D in the two groups showed a trend of first increasing and then decreasing,while Fib showed a trend of first decreasing and then increasing.Compared with the control group,PT and APTT in the VSD group were lower and Fib was higher at T_(1),T_(2)and T_(3)times,while D-D was lower at T_(2)and T_(3)time(P<0.05 for each).Conclusion Using single time covered VSD technology to treat on the bite of venomous snakes of Trimeresurus stejnegeri in Fujian can improve the swelling of the affected limb,reduce the pain,promote the recovery of coagulation function,and has a good clinical effect.

关 键 词：竹叶青蛇咬伤 负压封闭引流 凝血功能 视觉模拟评分 

分 类 号：R646[医药卫生—外科学]