持续封闭负压引流结合三棱针多点打孔对蝮蛇咬伤的治疗效果观察

Clinical study of early vacuum sealed drainage and detoxification with triangle-edged needle acupuncture therapy for Agkistrodon venom injury

目的：观察腹蛇咬伤后咬伤部位早期持续封闭负压引流（VSD）结合三棱针打孔法治疗的效果.方法：根据患者中毒时间、病情严重程度采用配伍设计,选取2012年7-8月份我院接诊手部腹蛇咬伤肿胀患者40例,随机分为A组（切开引流组,10例,在咬伤部位行＂＋＂字形切开至皮下层）、B组（切开引流＋VSD组,10例,伤口＂＋＂字形切开,然后行持续VSD）、C组（单纯三棱针打孔组,10例,在咬伤伤口周围用三棱针多点打孔20～30个）和D组（三棱针打孔＋VSD组,10例,在咬伤伤口周围用三棱针多点打孔20～30个,然后行持续VSD）.入院后同时给予抗腹蛇毒血清、抗感染及中医中药等治疗.观察患者患肢肿胀消退时间、伤口部位感染、脓肿、坏死发生率及住院时间.结果：①各组间患肢肿胀消退时间差异显著,D组明显低于A、B、C组[（2.1±1.5）d比（5.0±2.7）d,（3.4±1.7）d,（3.1±3.0）d;P〈0.05];②B、D组无一例出现伤口部位感染、脓肿形成及坏死,与A、C组（20%和40%）比较差异显著（P〈0.05）.③各组间伤口愈合时间及住院时间差异显著,D组均明显低于A、B、C组[（3.5±1.5）d比（7.5±2.5）d,（5.3±1.3）d,（4.7±1.3）d; P〈0.05].结论：腹蛇咬伤后咬伤部位早期三棱针打孔法结合持续VSD可显著缩短患者患肢肿胀消退时间及住院时间.

Objective： To study the effect of early vacuum sealed drainage （VSD） combined with acupuncture with triangleedged needle therapy for Agkistrodon venom injury. Methods：Forty patients with Agkistrodon bite iniury on feet and hands from July to August 2012 were collected and they were divided into 4 groups （n= 10） according to the injury time and severi- ty. In the incision group, the wounds were cross-incised early. In the incision2＂VSD group, the wounds were likely incised and treated with vacuum sealed drainage. In the needle-puncture group, 20-30 sites around the bite site were punctured with triangle-edged needle In the punching2＂VSD group, both triangle-edged needle puncture and VSD were performed. All patients received the treatment of the specific antivenom for Agkistrodotoxin, antibiotics and traditional Chinese medicine after admission. The duration of swelling, incidence of wound infection, sign of necrosis and hospitalization time were recorded. Results：①The time of swelling in punching ＋ VSD group [（2. 1±1.5） days] was shorter than that in incision group, incision＋ VSD group, and acupuncture group E （ 5.0 ± 2.7） days, （ 3.4 ± 1.7） days, （ 3.1 4± 3.0） days ; P〈 0.05]. ② There was no incidence of wound infection and necrosis in incision2 VSD and acupuncture ＋ VSD groups （0 and 0）, and it was obviously milder than incision and acupuncture groups （20% and 40%, P〈0.05）. ③Hospitalization time of acupuncture ＋ VSD group [（3.5±1.5）days] was also shorter than that of incision group, incision＋VSD group, and acupuncture group [（7.5±2.5）days, （5.3±4-1.3）days, （4.7±1.3）days; P〈 0. 05）. Conclusions：The treatment with triangle-edged needle acupuncture around the wound in the early stage, combined with VSD,after Agkistrodon bite could shorten the time of swelling and hospitalization time.