一次性覆盖式负压引流敷料在竹叶青属毒蛇咬伤救治中的临床研究  

Application of disposable covered VSD in treating the venomous snakebite of Trimeresurus stejnegeri

作　　者：黄国亮 陈冰冰 陈黎明 罗毅[2] HUANG Guo-liang;CHEN Bing-bing;CHEN Li-ming(Emergency Department, The 910th Hospital of People’s Liberation Army Joint ServiceSupport Force, Quanzhou 362000, China;不详)

机构地区：[1]解放军联勤保障部队第910医院急诊科,福建泉州362000 [2]柳州市中医院急诊科,广西柳州545001

出　　处：《中国医学装备》2022年第6期109-113,共5页China Medical Equipment

基　　金：广西壮族自治区卫生健康委青年基金(Z20200021)“覆盖式VSD技术运用于广西竹叶青属毒蛇咬伤的临床研究”;泉州市科技计划项目(2020N55s)“覆盖式VSD技术应用于福建竹叶青属毒蛇咬伤的临床研究”。

摘　　要：目的:探讨一次性覆盖式负压引流敷料(VSD)在竹叶青属毒蛇咬伤患者救治中的效果。方法:选取医院收治的120例竹叶青属毒蛇咬伤患者,按照随机数表法将其分为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。采用《中国蛇伤急救学》三度分类法评估两组患者患肢治疗前(T;),治疗后第1d(T;)、第4d(T;)和第7d(T;)患肢肿胀程度,采用视觉模拟评分(VAS)评估T;、T_(0)、T_(1)和T_(2)时的肢体疼痛程度;比较两组患者凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)和D-二聚体(D-D)等血液相关指标。结果:两组患者在T;时患肢肿胀程度差异无统计学意义,但在T_(0)、T_(1)和T_(2)时差异具有统计学意义(χ^(2)=14.306,χ^(2)=26.380,χ^(2)=15.016;P<0.05)。VSD组在T_(0)、T_(1)和T_(2)时双侧肢体周径差值和VAS评分均显著低于对照组(t;=15.958,t=26.113,t=23.610;t;=18.719,t=18.875,t=21.683;P<0.05)。两组患者在治疗过程中PT、APTT和D-D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。与对照组相比,VSD组患者在T_(0)、T_(1)和T_(2)时PT及APTT均较低,Fib较高;而在T;和T;时D-D较低(t;=23.788,t=33.375,t=26.647;t;=20.695,t=16.071,t=17.754;t;=13.942,t=17.603,t=17.958;t;=25.044,t=17.837;P<0.05)。结论:采用一次性覆盖式负压引流敷料治疗福建竹叶青属蛇咬伤,能够改善患者患肢的肿胀,降低疼痛,促进凝血功能恢复,具有较好的临床疗效。Objective:To explore the application effect of disposable covered vacuum sealing drainage(VSD) in treating the venomous snakebite of Trimeresurus stejnegeri.Methods:120 patients with venomous snakebite of Trimeresurus stejnegeri who admitted to hospital were randomly divided into VSD group and control group,with 60 cases in each group.On the basis of conventional treatment,the control group was treated with 50% magnesium sulfate gauze for wet dressing on the injured limb,while the VSD group was treated with dressing of disposable covered VSD.The three-degree classification method of “Chinese Emergency Medicine for Snakebite" was adopted to assess degrees of swell on the injured limb of patients before treatment(T;),the first day(T;),the fourth day(T;) and the 7 th day(T;) after treatment.And the visual analogue scale(VAS) was adopted to assess the pain degree of limb at T;,T;,T;and T;.And the bloodrelated indicators included prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fib) and D-dimer(D-D) between two groups were compared.Results:The difference of swell degree at T;between two groups was significant,while the differences of that at T;,T;and T;between two groups were significant(χ~2=14.306,χ~2=26.380,χ~2=15.016,P<0.05).The differences of peripheral diameters of bilateral limbs at T;,T;and T;,as well as VAS score in VSD group were significantly lower than those in control group(t peripheral diameter difference=15.958,t=26.113,t=23.610,t;=18.719,t=18.875,t=21.683,P<0.05).The PT,APTT and D-D appeared a trend of first increasing and then decreasing,while Fib showed a trend of first decreasing and then increasing.Compared with those of control group,PT value and APTT value in VSD group were significantly lower and Fib value was significantly higher at T;, T;and T;,while D-D in VSD group was lower at T;and T;(t;=23.788,t=33.375,t=26.647,t;=20.695,t=16.071,t=17.754,t;=13.942,t=17.603,t=17.958,t;=25.044,t=17.837,P<0.05).Conclusion:The disposable covered VSD can improve the swell,and re

关 键 词：竹叶青蛇咬伤 负压封闭引流(VSD) 凝血功能 视觉模拟评分(VAS) 

分 类 号：R646[医药卫生—外科学]