北京及周边部队蛇咬伤伤情分析及救治研究

Research of treatment and analysis of snakebite injury in Beijing and the servicemen in vicinity

目的:研究北京及周边部队蛇咬伤的发病、致伤及救治情况。方法:回顾性分析我科2006年6月—2011年9月接诊的42例北京及周边部队蛇咬伤患者的临床资料。患者就诊后均接受精制抗蝮蛇毒血清6 000U静脉滴注、伤处近心端以糜蛋白酶等局部注射封闭、抗生素预防感染、季德胜蛇药片口服及外用等治疗。比较治疗前后肝肾功能、心肌酶、凝血指标及血小板的变化,并与20例健康体检者(正常对照组)的指标进行对照。结果:42例患者经治疗均好转出院,未留后遗症。13例患者出现脏器功能损害;11例患者出现凝血系统功能障碍,其丙氨酸转氨酶(AIT)、总胆红素(TBil)、心肌酶及血浆凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原浓度(Fg)均明显高于正常对照组(P<0.05),治疗后恢复至正常水平。结论:蛇咬伤在北京及周边部队有一定的发病率,可影响肝功能、心肌酶和凝血系统,基层医疗机构应当进行必需的药品配备及救治技术培训。

Objective：To study the incidence, conditions and treatment of snakebite injury in Beijing and servicemen stationed in its vicinity. Methods： The clinical data of 42 cases of snakebite injury in Beijing and the servicemen in its vicinity treated in our department during June 2006 to September 2011 were reviewed. All the patients received the managements including intravenous injection of 6 000 U antivenom serum for Agkistrodon halys,intramuscular injection of chymotrypsin at the injury site and proximal to the injury,antibiotics to prevent infection,and J idesheng snakebite tablets （季德胜蛇药片） orally and topically. The changes in liver function, renal function, myocardial enzymes,coagulation function, and count of platelet before and after antivenom therapy were observed. Twenty healthy individuals served as controls. Results： All the 42 cases were cured without any sequela. Organ dysfunction was found in 13 cases, and coagulation system dysfunction was found in 11 cases,in whom the levels of alanine aminotransferase, total bilirubin,myocardial enzyme, prothrombin time, thrombin time,fibrinogen were significant higher than those of the normal control group （P〈0.05）, but all of them returned to normal after management. Conclusions： Snakebite injury occurs not uncommon in the vicinity of Beijing, among both inhabitants and servicemen. Liver function, a rise of myocardial enzyme and some indexes of coagulability functions are abnormal in certain proportion of victims. The primary health care sectors should be equipped with the necessary drugs,and the staff thereof should be trained to offer proper treatment.