抗蝮蛇毒血清联用低分子肝素钠治疗重症蝮蛇咬伤40例  

Antipit viper venom regimen combined with low molecular weight heparin sodium injection in the treatment of severe pit viper bite:a report of 80 cases

作　　者：杨中波 张丰 YANG Zhongbo;ZHANG Feng(Department of Emergency,Lujiang County People's Hospital,Hefei,Anhui 231500,China)

机构地区：[1]庐江县人民医院急诊科,安徽合肥231500

出　　处：《安徽医药》2022年第8期1679-1682,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的观察低分子肝素钠在重症蝮蛇咬伤病人治疗中的临床价值。方法采用前瞻性随机对照研究方法。选择2018年2月至2020年8月在庐江县人民医院就诊的重症蝮蛇咬伤病人80例作为研究对象。采用随机数字表法分为对照组(40例)和观察组(40例)。对照组采用传统抗蝮蛇毒血清治疗,观察组在对照组基础上加用低分子肝素钠治疗。比较两组肢体肿胀恢复时间、住院时间、视觉模拟评分(VAS)、凝血功能、炎症指标、心肌损伤标志物指标及并发症发生情况。结果经过治疗,两组均康复出院,无死亡病例。观察组与对照组肢体肿胀恢复时间比较,差异无统计学意义[(6.54±1.61)d比(6.92±2.12)d,P>0.05]。观察组住院时间低于对照组,差异有统计学意义[(8.35±1.41)d比(8.98±1.26)d,P<0.05]。观察组VAS(3 d)评分低于对照组,差异有统计学意义[(0.38±0.06)分比(0.86±0.24)分,P<0.05]。值得关注的是,治疗前,两组病人的血小板计数(PLT)、凝血功能差异无统计学意义(P>0.05),治疗3 d后,观察组病人PLT明显高于对照组[210(160,252)×10^(9)/L比165(124,203)×10^(9)/L,P<0.05],同时凝血酶原时间(PT)低于对照组[14.8(11.6,64.8)s比26.2(12.9,88.6)s,P<0.05]。治疗过程中观察组发生全身炎症反应综合征(SRIS)8例(20.0%),多器官功能障碍综合征(MODS)3例(7.5%),出血2例(5.0%)。对照组SRIS 14例(35.0%),MODS 5例(12.5%),出血16例(40.0%)。观察组并发症发生率(32.5%)明显低于对照组(87.5%),差异有统计学意义(P<0.05)。结论重症蝮蛇咬伤病人治疗中早期使用低分子肝素钠,治疗效果好且减少并发症的发生。Objective To observe the clinical value of low molecular weight heparin sodium in the treatment of severe pit viper bite.Methods A prospective randomized controlled study was conducted to select 80 patients with severe pit viper bite treated in the Lujiang County People's Hospital from February 2018 to August 2020 as the study subjects.According to the random number table method,patients were assigned into control group(n=40)and observation group(n=40).The control group was given traditional antipit viper venom regimen,and the observation group was given addtional low molecular weight heparin sodium.A comparison was made between the two groups of the recovery time for limb swelling,hospital stay,visual analogue scale(VAS),coagulation function,inflammatory indicators,markers for myocardial injury,and complications.Results Both groups recovered and were discharged and no death case was reported.The two groups showed no significant difference in the recovery time of limb swelling[(6.54±1.61)d vs.(6.92±2.12)d,P>0.05].The mean length of hospitalization in the observation group was shorter than that in the control group,which showed statistically significant difference[(8.35±1.41)d vs.(8.98±1.26)d,P<0.05].The VAS(3 d)score in the observation group was lower than that in the control group,which was statistically significant[(0.38±0.06)points vs.(0.86±0.24)points,P<0.05].It is worth noting that there were no significant differences in PLT and coagulation function(P>0.05)before treatment,but after 3 d of treatment,the PLT of patients in the observation group was significantly higher than that in the control group[210(160,252)×10^(9)/L vs.165(124,203)×10^(9)/L,P<0.05].Meanwhile,prothrombin time(PT)in the observation group was lower than that in the control group[14.8(11.6,64.8)s vs.26.2(12.9,88.6)s,P<0.05].Systemic inflammatory response syndrome(SRIS)occurred in 8(20.0%)cases of the observation group,multiple organ dysfunction syndrome(MODS)3(7.5%)cases and blood loss 2(5.0%)cases.The complication rate(32.5%)of the

关 键 词：蛇咬伤 蝮蛇属 低分子肝素钠 抗蝮蛇毒血清 

分 类 号：R646[医药卫生—外科学]