眼镜蛇咬伤致局部组织损伤的特点和治疗体会

Treatment of Local Tissue Damages by Naja naja atra Snakebite

目的探讨我国华南亚种眼镜蛇(Naja naja atra)咬伤所致局部损伤的特点和治疗体会。方法回顾我院收治的102例眼镜蛇咬伤病人的相关资料,观察比较受伤局部损伤情况和临床表现以及治疗方法与疗效等情况。结果所有病例均表现为牙痕周围组织不同程度的坏死和周边较大范围的炎症反应和局域淋巴结肿大,部分病例伴有或发热、困倦以及血WBC增高等表现,少数病例出现心、肝、肾功能轻度损害和溶血表现,未见典型神经麻痹病例和凝血功能障碍病例;84例实施了清创术,28病例实施了植皮手术,9例实施了筋膜室切开减压,2例实施了截肢术,所有病例在(17±6.2)天内痊愈,致残5例,无死亡病例。结论华南亚种眼镜蛇咬伤的特点是局部组织变性坏死,神经毒和血液循环毒方面的表现轻而少见,早期使用抗眼镜蛇毒血清是预防和减少局部组织损伤的的关键措施,在此基础上,及时清除坏死组织、积极抗炎消肿减压、尽早植皮覆盖创面对抑制局部损伤发展和促进组织修复以及加快痊愈有重要意义。

Objective To study the local tissue damages and treatment of Naja naja atra （Chinese cobra） bite. Mathods 102 patients with cobra snakebite were reported, their data about the local tissue damages and other symptoms, the surgery operations and the final cura- tive effect were collected and compared. Results All the 102 cases shown local tissue dama- ges to some extent, with a small part of patients shown mild damages of muscle, kidney, liv- er~ or other organs. The treatment measures included early application of antivenom of cobra and surgery operations such as debridement, dermatoplasty, and so on. Finally, all patient were cured in （17士6.2） days, except 5 cases of deformity. Conclusion The snakebite by cobra in South China mainly cause local tissue damages, seldom cause mild damages of liver, kidney and or muscle. The early application of antivenom is the most effective measure, be- sides, debridement and dermatoplasty together with detumescence and diminishing inflamma- tion are also important treatment measures.