竹叶青蛇咬伤中毒至DIC样综合征的临床研究

Research on DIC-like syndrome in patients with trimeresurus stejnegeri snakebite

目的 探讨毒蛇竹叶青咬伤引起DIC样综合征的临床中毒发病机制和治疗方法。方法 对来本院急诊确诊的竹叶青蛇咬伤 16例病人测定抗凝血酶原Ⅲ活性 (antithrombinⅢ ,AT -Ⅲ )、α2 -纤溶酶抑制物活性 (α2 -plasmininhibitor,α2 -PI)、纤维蛋白原浓度 (Fibrinogen ,Fg)和纤维蛋白降解产物含量 (FDP) ,并对治疗前后的检查结果进行对比。常规检查血小板计数 (plateletcount,PLT)和试管法凝血时间 (cruortime ,CT)。结果 治疗前AT -Ⅲ活性 [(5 6 6± 11 17) % ]、α2 -PI活性 [(2 8 4±5 85 ) % ]及Fg含量 (0 5 3± 0 16g/L)均比正常对照组明显减少 (P <0 0 1) ,但α2 -PI活性和Fg含量下降更明显 ;FDP含量(5 7 0± 8 4 8μg/mL)比正常对照组明显增多 (P <0 0 1)。 16例病人中CT延长有 10例 ,PLT低于正常范围有 11例。经治疗病人均痊愈出院 ,但检查发现血液学方面的恢复比较缓慢。结论 竹叶青蛇咬伤可引起病人体内的凝血和纤溶系统异常 。

Objective To research the mechanism and treatment of DIC-like syndrome induced by venom poisoning in the patients with Trimeresurus stejnegeri(Ts)snakebite Methods We measured antithrombin Ⅲ (AT-Ⅲ)activity,α 2-plasmin inhibitor (α 2-PI)activity,fibrinogen concentration (Fg)and level of fibrin degradation products (FD) in 16 patients with Ts bite and contrasted the results before and after treatment.The cruor time (CT)and platelet count (PLT) were also determined.Results Before treatment,the AT-Ⅲ activity 〔(56 6±11 17)%〕was decreased,α 2-PI activity 〔(28 4±5 85)%〕and Fg (0 53±0 16 g/L)was more markedly decreased, and FDP (57.0±8.48 μg/mL) was more markedly increased than normal range.The CT prolonged in 10 cases,and PLT decreased in 11 of 16 patients.All the patients recovered after treatment,but the hematological disturbances returning to normal level was slow.Conclusion After Ts bite,the patient may occur the abnormality in coagulation and fibrinolysis system and appear the defibrinogenation and DIC-like syndrome.[