五步蛇咬伤患肢早期切开引流的可行性和必要性研究

Feasibility and Necessity of Early Incision for Ancistrodon Acutus Injured Limb

目的探讨五步蛇咬伤患肢早期切开引流的可行性和必要性。方法回顾性分析我院2005—2011年间185例五步蛇咬伤患者的临床资料,按照患肢切开的时机分为A组和B组。A组患者为抗蛇毒血清使用完毕15 h后切开,B组患者为15 h内切开。比较两组患者大出血发生率、溃疡发生率以及治疗前后患肢肿胀情况。结果 A组患者出现大出血2例(2.2%),B组患者出现大出血6例(6.3%),两组比较差异无统计学意义(χ2=1.87,P>0.05)。A组患者出现患肢溃疡22例(24.4%),B组患者出现患肢溃疡11例(11.6%),两组比较差异有统计学意义(χ2=5.22,P<0.05)。入院时两组患者上肢及下肢周长比较,差异均无统计学意义(P>0.05);治疗7 d后B组患者上肢及下肢周长较A组减少,差异均有统计学意义(P<0.05)。结论选择合适的时机早期切开五步蛇咬伤的患肢,并不明确增加大出血的风险,且可明显降低溃疡发生率、促进患肢消肿。

Objective To explore the feasibility and necessity of early incision for Ancistrodon Acutus injured limb. Methods Clinical data of 185 cases of Ancistrodon Acutus injured patients admitted to our hospital from 2005 to 2011 were retrospectively analyzed. The patients were divided into group A and group B according to limb incision time. The group A was in- cised after 15 hours of antivenin, and the group B was incised within 15 hours. The massive hemorrhage rate, ulcer rate and limb swelling changes before and after treatment were compared between the two groups. Results 2 （2. 2%） cases from group A and 6 （6. 3% ） cases from group B had massive hemorrhage, and the difference between the two groups was not statistically signifi- cant （X2 = 1.87, P 〉0. 05） . 22 （24. 4% ） cases from group A and 11 （ 11.6% ） cases from group B had limb ulcer, and the difference between the two groups was statistically significant （X2 = 5.22, P 〈 0.05 ） . The upper and lower limb circumferences on admission between the two groups showed no statistically significant difference （ P 〉 0. 05 ） , but after seven days treatment, they showed statistically significant differences （ P 〈 0. 05 ） . Conclusion Early incision at appropriate time on Ancistrodon Acutus injured limb will not definitely increase the risk of hemorrhage, but can obviously eliminate the limb swelling and reduce ulcer rate.