广西竹叶青蛇咬伤后血液学动态变化及发生非典型DIC的观察分析

Dynamic changes of hematological parameter and atypical DIC study in the patients bitten by Trimeresurus stejnegeri in Guangxi

目的 动态观察广西竹叶青蛇咬伤后患者的血液学动态变化,并对发生的弥散性血管内凝血（DIC）的特点和机制进行分析探讨.方法 动态观察21例被广西竹叶青蛇咬伤患者的凝血功能指标：凝血酶原时间（PT）、纤维蛋白原（Fg）、D-二聚体（D-D）、血浆鱼精蛋白副凝试验（3P）和部分血常规指标：白细胞计数（WBC）、 红细胞计数数（RBC）、中性粒细胞计数（N）、血小板计数（PLT）和血红蛋白量（HGB）.观察患者的临床表现和发生DIC的特点.结果 21例被广西竹叶青蛇咬伤患者有不同程度的出血倾向;咬伤患者中发生DIC的共17例（80.95%）,其中13例（76.47%）发生在咬伤后0～48 h;全部DIC患者无休克和其他脏器无严重功能障碍发生等,也无死亡病例.动态观察发现,各凝血功能指标发生异常的高峰时间是在被伤后24～72 h,分别出现PT延长、Fg降低、D-D和3P阳性,但随时间推移各指标的异常率随之下降;在咬伤后48 h内,WBC和N平均值高于正常值,而HGB和PLT平均值在各时间段均属于正常值范围.结论 广西竹叶青蛇咬伤所至的DIC主要发生在咬伤后48 h内,同其他原因所致的DIC比较,具有不发生高凝期、临床表现相对较轻和预后好的特征,是不典型的DIC.

Objective To study the dynamic changes of hematological parameter in the patients bitten by Trimeresurus stejnegeri （T. stejnegeri ） in Guangxi, and to analyze the features of atypical disseminated intravascular coagulation （DIC） in these patients. Methods Clinical manifestations of 21 cases bitten by T. stejnegeri and characters of DIC patients were observed. Hemostatic parameters were observed dynamically, including the prothrombin time （PT） , fibrinogen （Fg） , D - dimer （ D - D ） , plasma protamine paracoagulation （3P） and white blood cell count（WBC）, neutrophil count（N）, red blood cell count （ RBC）, blood platelet count （PLT） , hemoglobin （HGB）. Results Hemorrhagic tendency happened in all cases, 17 cases were diagnosed as DIC （ 80.95% ）, 13 cases （ 76.47% ） of these DIC patients were occurred within 48 h. The peak time of abnormal hemostatic parameters were in the first 24 ~ 72 h after injured by the snake, including prolonged PT, low level of Fg, positive D - D and 3P. Though the counts of WBC and N cell were higher than normal level in the first 48 h, other parameters PLT, HGB were normal in observed time. Conclusion The most of DIC patients caused by the toxin of T. stejnegeri are occurred in the first 48 h. Compared with typical DIC, the atypical DIC caused by T. stejnegeri is manifested as bleeding, but there are no thrombosis and its relative manifest - ations as ischemia, gangrene and catastrophic events, and the atypical DtC have well prognosis characteristically.