蛇伤膏外敷联合中药口服辅助治疗蝮蛇咬伤风火毒证50例临床观察  

Fifty Cases of Agkistrodon Halys Bite with Wind-fire Syndrome Treated by External Application of Snakebite Ointment Combined with Oral Administration of Chinese Herbal Medicine

作　　者：李忠志[1] 徐桂琴[1] 蒋文晶[1] 周明明 曹承楼[1] 袁以洋[1] LI Zhongzhi;XU Guiqin;JIANG Wenjing;ZHOU Mingming;CAO Chenglou;YUAN Yiyang(First Affiliated Hospital of Anhui University of Chinese medicine,Hefei,230038)

机构地区：[1]安徽中医药大学第一附属医院,安徽合肥230038

出　　处：《中医杂志》2022年第13期1243-1248,共6页Journal of Traditional Chinese Medicine

基　　金：安徽中医药大学2020年度校级科学研究自筹经费项目(2020yfyzc12)。

摘　　要：目的观察蛇伤膏外敷联合中药口服辅助治疗蝮蛇咬伤风火毒证患者的临床疗效并探讨其可能的作用机制。方法将100例蝮蛇咬伤风火毒证患者随机分为治疗组和对照组,每组50例。对照组采用蝮蛇咬伤常规治疗方案,治疗组在对照组治疗基础上进行蛇伤膏外敷,每日1次,同时口服中药汤剂每次200 ml,每日2次,两组均连续治疗7天。观察两组临床疗效,比较治疗前及治疗第3天、第7天两组患者症状、体征积分,治疗前后肿胀、疼痛评分,以及治疗前后血清磷脂酶A_(2)(PLA_(2))、前列腺素E_(2)(PGE_(2))、白三烯B_(4)(LTB_(4))水平。结果两组患者临床疗效总有效率均为100.00%,但治疗组治愈率(66.00%,33例/50例)明显高于对照组(18.00%,9例/50例)(P<0.01)。与本组治疗前比较,两组患者治疗第3天、第7天症状、体征积分均明显下降,治疗第7天较第3天明显下降(P<0.01);治疗组治疗第3天、第7天症状、体征积分均低于同时间的对照组(P<0.05或P<0.01)。治疗后两组患者肿胀、疼痛评分及血清PLA_(2)、LTB4水平均低于治疗前,PGE_(2)水平均高于治疗前(P<0.05或P<0.01);治疗后治疗组肿胀、疼痛评分及血清PLA_(2)、LTB4水平均低于对照组,PGE_(2)水平高于对照组(P<0.05或P<0.01)。结论在常规治疗方案的基础上,蛇伤膏外敷联合中药口服治疗蝮蛇咬伤风火毒证能够明显改善患者肿胀、疼痛症状并提高临床疗效,其机制可能与调控PLA_(2)介导的炎症通路、减轻炎症反应有关。Objective To observe the clinical effect of external application of snakebite ointment combined with oral administration of Chinese herbal medicine in treating Agkistrodon Halys bite with wind-fire toxin syndrome,and explore its possible mechanism.Methods One hundred patients with Agkistrodon Halys bite were randomly divided into treatment group and control group,with 50 cases in each group.The control group received routine treatment,while the treatment group was additionally treated with snakebite ointment once a day,and oral administration of 200 ml Chinese herbal medicine twice daily.Both groups were treated continuously for one week.The clinical effect of the two groups were observed.The symptom and sign scores before treatment and on the 3 rd and 7 th day of treatment were compared.The scores of swelling and pain and the levels of serum phospholipase A_(2)(PLA_(2)),prostaglandin E_(2)(PGE_(2))and leukotriene B_(4)(LTB_(4))were measured before and after treatment.Results The total effective rate of both groups was 100%,but the curative rate of the treatment group was 66.00%(33/50),significantly higher than 18.00%(9/50)of the control group(P<0.01).Compared to pre-treatment,the scores of symptoms and signs decreased significantly on the 3 rd and 7 th day during treatment in both groups,and more decreases were found when comparing the scores measured on the 7 th day to those on the 3 rd day(P<0.01),and when comparing the scores of treatment groups to those of the control group(P<0.05 or P<0.01).After treatment,the scores of swelling and pain and the levels of serum PLA_(2)and LTB_(4)in both groups were lower than those before treatment,while the PGE_(2)level was higher(P<0.05 or P<0.01);the treatment group had lower swelling and pain scores and serum PLA_(2)and LTB_(4)levels,as well as higher PGE_(2)level than the control group(P<0.05 or P<0.01).Conclusion Compared to conventional treatment,the adjuvant therapy of snakebite ointment combined with oral administration of Chinese herbal medicine can improve swelli

关 键 词：毒蛇咬伤 蝮蛇 风火毒证 蛇伤膏 中药外敷 炎症通路 

分 类 号：R646[医药卫生—外科学]