竹叶青蛇咬伤凝血功能动态演变规律的探讨

The law of dynamic evolution of coagulation function in patients bitten by Trimeresurus stejnegeri

目的探讨竹叶青蛇咬伤患者凝血功能指标的动态演变规律。方法115例竹叶青蛇咬伤患者，咬伤后就诊当时未经干预治疗前，采集血标本，检测曲l小板计数（PLT）、纤维蛋白原（FBG）、活化部分凝血活酶时间（A丌r）及凝血酶原时间（PT）。按照咬伤后不同的时间段进行分段统计分析。结果PLT和FBG随发病时间的延长呈进行性下降，胛和APTT则进行性延长。其中，PLT在咬伤后24h低于正常值，第4天达最低值；FBG在咬伤后12h低于正常值，第4天达最低值；PT于咬伤后6-12h明显延长，第2天达最高值；APTT于咬伤后第3天明显延长。结论竹叶青蛇咬伤患者凝血功能指标随时问不同呈动态变化，可根据其变化规律来规范的预设毒蛇咬伤患者的住院时间，评估预后，指导临床治疗。

Objective To review the pattern about the progressive evolvement for the laboratory index of coagulation for Trimeresurns Stejnegeri bite cases. Methods The blood concentration of platelet（PLT）, fibrinogen （FBG）, as well as activated partial thromboplastin time （AFI＇T） and prothrombin time（PT） were immediately tested at visit time in 115 patients bitten by Trimeresurus stejnegeri before any treatment. And the data was alalyzed according to a different time from - bitten - to- visit. Results The study reviewed that PLT and FBG would progressively decline; PT and APTI＇ would increase progressively, which mean it would take longer in time to archive the normal level; PT would increase noticeably within 6 ~ 12 hours after the incident and would reach its highest level after 2 days; and AP＇I＊F would increase obviously after 3 days. The study also showed that PLT would be lower than normal 24 hours after being bitten and would reach the lowest level in 4 days. FBG would be leveled under normal 12 hours after the incident and would reach its lowest level in 4 days as well. Conclusion The laboratory index of coagulation for Trimeresurns stejnegeri bite cases varies progressively. The reviewed facts from our research will be helpful for us to set the clinical treatment procedures, to estimate the duration of hospitalization for patients of venomous snake bitten, and to make diagnosis and prognosis correctly.