蝮蛇解毒汤对蝮蛇咬伤致凝血功能障碍相关指标的影响  

Effect of Fushe Jiedu Decoction on Related Indexes of Coagulation Dysfunction Caused by Viper Bite

作　　者：陈海东 龚旭初 李逸梅 方勇 杨万富 郭檬檬 Chen Haidong;Gong Xuchu;Li Yimei;Fang Yong;Yang Wanfu;Guo Mengmeng(Nantong Hospital of Traditional Chinese Medicine,Jiangsu,Nantong 226001,China)

机构地区：[1]江苏省南通市中医院,江苏南通226001

出　　处：《中国中医急症》2023年第1期120-123,共4页Journal of Emergency in Traditional Chinese Medicine

基　　金：第七批全国老中医药专家学术经验继承项目(国中医药人教函[2022]76号);国家中医药管理局重点专科项目(国中医药办医政函[2019]210号);江苏省中医药重点学科(中医外科)项目(苏中医科教[2018]1号);南通市“十四五”科教强卫工程临床医学中心及青年医学重点人才项目(通卫科教[2021]15号)。

摘　　要：目的观察蝮蛇咬伤诊治过程中相关凝血指标的改变情况,评价蝮蛇解毒汤在对蝮蛇咬伤致凝血功能障碍指标的影响。方法收集有凝血功能障碍的蝮蛇咬伤患者114例,其中西医对照组患者51例,治疗组患者63例。对照组方案为西医常规治疗,治疗组在对照组治疗基础上加用蝮蛇解毒汤口服。统计分析两组出血凝血相关指标[常规凝血实验(CCT)、血小板计数(PLT)、血小板聚集功能(PAgT)、试验血栓弹力图(TEG)]。结果治疗后两组凝血酶原时间(PT)、部分凝血酶原时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(D-dimer)均明显改善,且治疗组改善均优于对照组(P<0.05或P<0.01);治疗组PLT较前改善(P<0.05),但与对照组相比差异无统计学意义(P>0.05);两组PAgT中相关指标二磷酸腺苷(ADP)、胶原(COL)较前均改善显著(P<0.01),治疗组优于对照组(P<0.05),两组花生四烯酸AA差异无统计学意义(P>0.05);两组TEG中凝血因子活性R、纤维蛋白原功能K、纤维蛋白原功能α、血小板功能MA、凝血综合指数CI均显著改善,且治疗组MA值、CI值、R值优于对照组(P<0.05),纤溶指标EPL、LY30仅治疗组较治疗前改善(P<0.05)。结论蝮蛇咬伤导致的凝血功能障碍需要采用多种检测方案综合判断,加用蝮蛇解毒汤口服可以改善出血凝血相关指标,促进血小板功能恢复。Objective:To evaluate the effect of Fushe Jiedu Decoction on the indexes of coagulation dysfunction caused by viper bite by observing the changes of related coagulation indexes during the diagnosis and treatment.Methods:A total of 114 patients with coagulation dysfunction who met with the inclusion requirements were selected and divided into the control group(51 patients)and treatment group(63 patients).The control group was treated with conventional western medicine,and the treatment group with Fushe Jiedu Decoction on the basis of the control group.The coagulation related indicators(CCT,PLT,PAgT,TEG)were statistically analyzed between the two groups.Results:After treatment,the prothrombin time(PT),partial prothrombin time(APTT),thrombin time(TT),fibrinogen(FIB),and D-dimer(D-dimer)were significantly improved in the two groups,and the improvement in the treatment group was better than that in the control group(P<0.05),among which there were significant differences in APTT and D-dimer(P<0.01);PLT in the treatment group improved(P<0.05),but there was no significant difference compared with the control group(P>0.05);the related indexes adenosine diphosphate(ADP)and collagen(COL)in PAgT in the two groups were significantly improved(P<0.01),and the results in the treatment group was better than those of the control group(P<0.05),while there was no significant difference in arachidonic acid(AA)between the two groups(P>0.05);the coagulation factor activity R,fibrinogen function K,fibrinogen functionα,platelet function MA and coagulation comprehensive index CI in the TEG of the two groups were all improved,and the MA value,CI value and R value in the treatment group were better than those in the control group(P<0.05),and the fibrinolytic indexes EPL and LY30 were only improved in the treatment group(P<0.05).Conclusion:The coagulation dysfunction caused by viper bite needs to be comprehensively judged by a variety of detection schemes.The addition of Fushe Jiedu Decoction can promote coagulation related indicators and r

关 键 词：蝮蛇咬伤 凝血障碍 蝮蛇解毒汤 

分 类 号：R646[医药卫生—外科学]