大剂量糖皮质激素联合抗蛇毒血清在竹叶青蛇伤致DIC临床观察

The Study of the Effect of High Dose Giucocorticoid Associated with Antivenomous Serum in the Treatment for Patients of Trimeresurus Stejnegeri Snakebite Induced DIC

目的观察大剂量糖皮质激素联合抗蛇毒血清在治疗竹叶青蛇伤致 DIC 中的疗效。方法 57例竹叶青蛇伤致DIC 患者按单盲随机法分为两组,对照组28例,治疗组29例。对照组:常规综合治疗+抗蝮蛇血清;治疗组:在对照组基础上加用甲基泼尼松龙1000mg/d,观察两组疗效及凝血酶原时间(PT)、纤维蛋白原(Fg)和血小板(PLT)的恢复时间。结果治疗组总有效率96.6%,对照组75.0%,两者差异有显著性(P<0.05);治疗组 PT、Fg、PLT 与对照组比较,有显著性差异(P<0.05)。结论大剂量糖皮质激素联合抗蛇毒血清治疗竹叶青蛇伤致 DIC 可明显缩短凝血指标恢复时间及提高疗效。可以对竹叶青蛇毒起较好的中和作用,取得满意的临床治疗效果。

Objective To observe the effect of the combined therapy of high dose glucocorticoid associated with antivenomous serum in the treatment for patients of Trimeresurus stejnegeri snakebite induced DIC.Method Fifty-seven patients of Trimeresurus stejnegeri snakebite in- duced DIC were divided into two groups at random,the control group included 28 patients,the test group included 29 patients.The contol group were treated by routine complex treatment associated with refined viper antitoxin,the test group were added 1000mg/d Methylprednisolone than the control group.To observe the improved time of prothrombin time,fibrinogen and platelet.Result The rate of the improvement is 96.6% in the test group and 75.0% in the control group,it has significantly different in the two groups.Levels of prothrombin time,fibrinogen and platelet in the test group were improved significantly more quick than the control group.Conclusion High dose glucocorticoid associated with antivenomous serum in the treatment for patients of Trimeresurus stejnegeri snakebite induced DIC can shorten the improved time of the hemostatic markers,and improve the effect of the treatment.