五步蛇伤患肢肿胀不能切开引流吗?

Can't the limb swelling after ancistrodon acutus bite be treated with incision and drainage?

五步蛇属血循毒类毒蛇,被其咬伤后不但会造成肢体严重肿胀,而且会破坏机体的凝血机制,严重时会导致DIC的发生。故既往临床工作者往往不主张患肢切开引流消肿。即使患肢出现感染、化脓也只主张抽出脓液。但炎症水肿引起的患肢肿痛,不但导致患者极为痛苦,而且会促进患肢感染、导致骨筋膜室综合征等,使得患肢血运进一步受损,从而出现严重的溃疡甚至肢体坏死。是否切开患肢引流以及切开的时机怎么确定,目前还具有较大争议。我们认为选择合适的时机切开引流减压并不会造成大出血,还可以促进患肢消肿,对预防患肢感染、溃疡和伤残等都具有积极的作用。

Ancistrodon acutus is a kind of poisonous snake that can make the bitten limb swell up seriously and destroy the victim＇s blood coagulaton mechanism, even can lead to diffuse intravascular coagulation. So, in most cases clinical workers do not open the swollen limb, even if the affected limb has developed infection or festering. They often advocate extracting the pus. The inflammatory edema caused by limb swelling not only brings the patient acute pains, but also promotes the limb infection, even leads to osteofascial compartment syndrome that may further damage the blood supply of the limb. As a result, the limb may experience serious ulcer and necrosis. So far, there are a lot of great disputes pertaining to whether to open the affected limb and how to make sure the time. In our opinions, if the time of incision and drainage is appropriate, massive hemorrhage could be avoided. What＇s more, proper incision and drainage can facilitate the detumescence, prevent limb infection, ulcer and disability, and so on.