中华眼镜蛇咬伤致局部皮肤软组织肿胀坏死的治疗探讨

Approach of therapy for swell and necrosis in local skin and soft tissue induced by Chinese cobra snakebite

目的 探讨中华眼镜蛇咬伤致局部皮肤软组织肿胀坏死合理有效的治疗方法.方法 回顾性分析本院2003年6月至2009年12月收治90例中华眼镜蛇咬伤中毒患者的临床资料,按治疗方法不同分为季德胜蛇药片组（20例）、40%硫酸镁甘油组（26例）、磺胺嘧啶银霜组（25例）、重组人表皮生长因子（rh-EGF）组（19例）,分别用相应药物外敷治疗局部皮肤软组织肿胀坏死,每日换药1次,观察各组患者伤口消肿时间和愈合时间.结果 磺胺嘧啶银霜组伤口消肿时间[（8.72±1.89） d]明显短于季德胜蛇药片组[（11.20±2.73） d]、40%硫酸镁甘油组[（10.42±2.00） d]与rh-EGF组[（11.68±2.54） d],差异均有统计学意义（均P〈0.05）;而3组间比较差异无统计学意义（均P＞0.05）.rh-EGF组伤口愈合时间[（18.21±6.96） d]明显短于季德胜蛇药片组[（23.40±7.24） d]、40%硫酸镁甘油组[（24.38±7.50） d]与磺胺嘧啶银霜组[（22.92±6.81） d],差异有统计学意义（均P〈0.05）;而3组间比较差异无统计学意义（均P＞0.05）.结论 治疗中华眼镜蛇咬伤所致的局部皮肤软组织肿胀坏死,磺胺嘧啶银霜有助于消肿,rh-EGF有助于愈合.

Objective To approach the effective therapy of the swell and necrosis in local skin and soft tissue induced by Chinese cobra snakebite. Methods The clinical data of 90 patients bitten by Chinese cobra treated in the First Affiliated Hospital of Guangxi Medical University from June 2003 to December 2009 were retrospectively analyzed, and they were divided into four groups by different treatment ： Jidesheng snake tablet （季德胜蛇药片） group （20 cases）, 40% magnesium sulfate glycerol group （26 cases）, sulfadiazine silver group （25 cases） and recomhination human epidermal growth factor （rh-EGF） group （19 cases）. These four groups respectively received their corresponding drugs, and the method of application was external compress at local lesion until the wound healed. Detumescence time and healing time were compared and analyzed in various groups. Results The mean detumescence time of sulfadiazine silver group [（8.72± 1.89） days] was shorter than that of Jidesheng snake tablet group [（11.20±2. 73） days], 40% magnesium sulfate glycerol group [（10. 42±2.00） days] and rh-EGF group [11.68± 2.54） days], there were differences of statistical significance （all P〈0.05）, but there was no difference of statistical significance among the latter three groups （all P〉0.05）. The mean healing time of rh-EGF group [（18.21±6.96） days] was remarkably shorter than that of Jidesheng snake tablet group [（23.40± 7.24） days], 40% magnesium sulfate glycerol group [（24.38± 7.50） days] and sulfadiazine silver group [（22.92 ±6.81） days], and there were differences of statistical significance （all P〈0.05）, but there was no difference of statistical significance among the latter three groups （all P〈0. 05）. Conclusion In the treatment of the swell and necrosis in local skin and soft tissue induced by Chinese cobra snakebite, the sulfadiazine silver helps in eliminating swelling, and the rh-EGF promotes healing.