蝮蛇咬伤10885例救治分析

An Analysis of the 10 885 Cases on How to Treat the Bites by Agkistrodon halys

目的 探讨提高蝮蛇咬伤的救治水平 方法 回顾性总结我院 1 972～ 1 999年蝮蛇咬伤患者1 0 885例 ,采用抗蝮蛇毒血清结合中药蛇伤合剂治疗 ;对合并急性呼吸衰竭的 85例患者 ,早期气管切开 ,保持气管畅通 ,同时正压人工呼吸 ;对合并急性肾功能衰竭的 1 0 3例患者 ,早期碱化尿液 ,应用足量利尿剂 ,必要时进行腹膜透析 ;对合并急性心功能衰竭的 4 3例患者 ,在应用强心、利尿、扩血管药物的同时 ,早期静脉给予山莨菪碱 ( 654-2 ) ;对合并多器官功能衰竭的患者 ,注意保护各脏器功能和内环境稳定 ,并加强营养支持 结果 本组治愈 1 0 84 7例 ;死亡 38例 ,其中死于急性呼吸衰竭 1 7例 ,死于急性肾功能衰竭 1 2例 ,死于急性心功能衰竭 4例 ,死于多器官功能衰竭 5例 结论 伤后早期有效的排毒、解毒、保护和改善心、肺。

Objective To deal with raising the level of treatment on the bites by Agkistrodon halys Methods The summing up in retrospect of the experience in cure of the snakebites in the 10 885 cases from 1972 to 1999,adopting antiviper venom serum in combination with traditional Chinese medicine snakebite agent to cure it To the 85 cases who are in acute respiratory failure at an earlier period,operating the tracheotomy,keeping the trachea unimpeded,and at the same time carrying on artificial respiration of positive pressure;To the 103 cases who are in amalgamated acute renal failure,with the earlier alkalization urine,should be dealt with sufficient amount of diuretic,if necessary,peritoneal dialysis may be conducted;To the 43 cases of amalgamated acute heart failure,when the drugs for cardiac stimulation,diuresis and blood vessel dilatation are applied,intravenous injection of anisodamine(654 2) may be given at an earlier period;To the 8 cases of multiple system organ failure attention should be paid to protecting the function of all organs and the constancy of inner environment and strengthening the sustenance of nutrition Rusults The cure amount of this group is 10 847 cases;the mortality is 38 cases,17 of which dying from acute respiratory failure and 12 of which dying from acute renal failure,4 of which dying from acute heart failure and 5 of which dying from multiple system organ failure Conclusions The key to raising the cure rate of the snakebite is effective repelling poison,detoxification and the improvement of the function of many important organs,such as heart,lung and kidney after being bitten by viper at the earlier period