北方地区蝮蛇咬伤致VICC的风险评估与护理观察

Risk estimation and nursing observation of venom-induced consumptive coagulopathy caused by Agkistrodon Halys in North China

目的探讨北方地区蝮蛇咬伤致VICC的临床出血风险评估、护理措施与观察。方法对2008年6月-2013年8月解放军总医院第一附属医院急救部确诊为蝮蛇咬伤致VICC并住院治疗的23例患者在入院后进行临床出血风险评估、制定针对性护理举措，对临床观察情况进行总结分析。结果23例患者中18例（78．3％）评分0分，2例（8．7％）0〈评分〈1，3例（13％）1≤评分〈2，无评分≥2病例；分别于伤后14-62h确诊VICC，平均（32．7±12．1）h，持续时间最短4d，最长13d，平均（8．6±2．0）d；临床表现主要为皮下出血、瘀斑，发生23例（100％），均未发生严重颅内、内脏出血等并发症；2人自动出院，21人（91．3％）痊愈出院。结论北方地区蝮蛇咬伤所致VICC经合理治疗、严密护理观察，可避免或减少颅内出血、内脏出血甚至死亡等严重并发症的风险。

Objective To explore the hemorrhage risk estimation, clinical nursing and observation of venom-induced consumptive coagulopathy caused by Agkistrodon Halys in North China. Methods The hemorrhage risk estimation, clinical nursing and observation of 23 cases diagnosed VICC caused by Agkistrodon Halys during June 2008 and August 2013 were summarized and analyzed. Results The scores of hemorrhage risk estimation were 0 in 18 cases. 〉0 and 〈 1 in 2 cases. ≥1 and 〈2 in 3 cases. No cases＇ score ≥2. 23 cases were respectively diagnosed VICC 14h to 62h after injury. The mean time course was 32.7± 12.1h. The shortest VICC duration was 4 days and the longest was 13 days. The mean was 8.6±2.0 days. The main clinical feature was subcutaneous hemorrhage and ecchymosis. The incidence was 100%. No intracranial hemorrhage, internal bleeding or other complications. 2 cases discharged volunteered. 21 cases discharged after fully cured. Conclusion Affording proper treatment and close nursing and observation, severe complications such as intracranial hemorrhage, internal bleeding even death can be avoided or decreased in patients with VICC caused by Agkistrodon Halys in North China