重症五步蛇咬伤深筋膜室网状切开的早期应用

Early application of deep fascia netted incision in severe patients for Agkistrodon acutus bite

目的探讨重症五步蛇伤患者行深筋膜室网状切开的早期应用。方法选择2007年4月～2011年12月我院收治被五步蛇咬伤后3h内就诊,且患肢组织压在25mmHg以上的患者44例,其中行深筋膜室网状切开13例作为研究组(A组),使用传统保守非手术治疗31例作为对照组(B组),观察两组患者72h内组织压的变化、肿胀程度的改变、创口出血及坏死情况,并进行比较。结果两组比较,A组24h后组织压基本降至正常,肿胀程度比B组轻;A组患者伤口有明显出血渗血,早期B组优于A组,但3h后两组的出血情况对比无明显差异。A组2例患者伤处有片状坏死;B组绝大部分患者72h后经切除坏死组织后肿胀明显消退,1例患者因骨筋膜室综合征导致截肢,两组对比有显著统计学差异。结论在重症五步蛇伤中,审慎深筋膜室网状切开患肢,可避免组织坏死、骨筋膜室综合征形成及大出血的发生。

Objective To explore early application of deep fascia netted incision in severe patients for Agkistrodon acutus bite.Methods 44 patients for Agkistrodon acutus bite were selected from April 2007 to December 2011.Each patient must visit within 3 hours after injury and his tissue pressure was above 25 mmHg.13 case with deep fascia netted incision were called study group（group A）,Another 31 case with tradition treatment were called control group（group B）.The changes of their tissue pressure,swelling degree,hemorrhage and necrosis in 24 hours were observed.And contrasted the two groups.Results Tissue pressure of group A was down to normal after 24 hours,degree swelling of group A was lower than one of group B,but patients,wound had obvious bleeding in group A in early stage,there were no difference after incision 3 hours in two group.Most of the patients,swelling degree had reduced significantly after 72 hours for the excision of necrotic tissue in group B,1 cases patients had to amputation for osteofascial compartment syndrome finally,statistical difference was significant in two group.Conclusion Prudential deep fascial netted incision on the affected limb in severe patients for Agkistrodon acutus bite can avoid tissue necrosis,formation of osteofascial compartment syndrome and massive hemorrhage.