蛇伤中毒后的心肺脑复苏研究

Study on CPCR For Snakebite Poisoning

近年来我们在广西直接收治蛇伤病人1782例。其中发生呼吸停止或呼吸心跳停止的病人共65例,此65例中被眼镜王蛇咬伤2例、眼镜蛇和蝰蛇咬伤引起呼吸心跳骤停各1例,银环蛇咬伤引起呼吸心跳骤停30例,引起呼吸停止31例。病人最小年龄5岁,最大60岁。男61例,女4例。被咬伤的部位均为上肢或下肢。被咬伤后至发生自主呼吸停止从10分钟至23小时,呼吸停止至自主呼吸恢复最短的2小时,最长329小时,多数为50～120小时。主要治疗方法为使用定时压力切换型同步呼吸机及高频喷射呼吸机进行人工呼吸,并配合使用上海生物制品研究所生产的单价抗蛇毒血清,广西蛇药,局部注射胰蛋白酶,新斯的明、654—2、地塞松及一般对症治疗。此65例病人经抢救59例治愈,6例死亡。总治愈率为90.77％。65例中有42例已符合脑死亡诊断标准,但经用中西医结合的现代技术,进行抢救仍有37例治愈,治愈率为88.1％,其病死亡率为11.9％。65例中单纯呼吸停止或呼吸心跳停止的病人共23例。治愈22例,治愈率为95.65％,其病死亡率为4.35％。本文并结合对蛇伤引起的呼吸心跳停止与符合临床脑死亡诊断标准的病人及抢救方法和措施进行初步的探讨。

In the reccnt years we have personnaly treated 1782 cases of snakebite, 65 of which suffered the sudden arrest of either respiration or heartbeat, including 61 cases bitten by Bungarus multicinctus Blyth, 2cases by king Cobra, one by Cobra and one Russell's Viper. Among these cases, there are 30 bited by Bungarus multicinctus Blyth(Banded krait) and involuing sudden arrest of both respirations heartbeats, and however, 31 cases sudden arrest of respiration only. The ages of patients vary from, the youngest, five years old, to, the oldest, sixty, male 61, female 4. The bitten wounds are mostly on either upper or lower extrimitie. To the onset of autonomous respiratory arrest from ten minutes to the twenty three hours, the duration from the respiratory arrest to recover of autonomous respiration, is two hours, and longest three hundred twenty nine, most of them range the 50—120 hours. The fundamental treatments are to use respirator(ventilator) to be In progress of artificial respiration with monovalent (antivenmous) serum (made in China) snake drug Guangxi, delivier by local injection with trypsin, neostigmenum, 654-2, dexamethasonum, and suit the medicine to the illness. Of the 65 cases, 59 cases are cured after lifesaving, except 6 cases of death, the total cure rates up to the 90.77％. Among them, 42 cases come up already to the standard of the brain death (cerebral death), but 37 cases of them are cured, with combined usage of our traditional and modern medicine, the cure ranging 88.95％, except 5 cases of death, its mortality 11.9％. In the 65 cases, arrest of the respiration only and bothrespiratory and heartbeat stop totals to 23 cases, of these 23 cases, 22 cases got cure rating to 95.65％, mortality 4.3％. We will discussthe respiratory and cardiaclest arrest causea by bites of snakes and comfirming to the standard of the cerebral death in the following.