蛇伤胶囊对竹叶青蛇伤患者血小板及凝血时间的影响

Study of the Sheshang Capsule affecting platelet and clotting time of patients bitten by the Trimeresurus stejnegeri

目的研究中药蛇伤胶囊治疗竹叶青蛇伤患者凝血障碍的机制。方法将70例竹叶青蛇伤(均符合火毒证诊断标准)患者按SPSS统计软件产生随机数分为治疗组和对照组各35例。两组基础治疗方法均为伤口消毒处理,肌注破伤风抗毒素1500u,使用常规量抗生素,给予地塞米松10mg、奥美拉唑40mg等。对照组在基础治疗上口服季德胜蛇药片10片,每天3次;治疗组在基础治疗上口服蛇伤胶囊5粒,每天3次。两组疗程均为1周。观察两组治疗前后血小板计数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)、凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)水平。结果治疗前,两组TT、PT、APTT、FIB、PLT、MPV、PDW比较,差异无统计学意义(均P>0.05);治疗后,治疗组FIB、PLT、MPV、PDW升高值(差值)高于对照组(P<0.05或P<0.01),而且治疗组TT、PT、APTT下降值(差值)高于对照组(P<0.01)。结论蛇伤胶囊具有减少凝血因子消耗、抗纤溶、改善血小板及其止血功能而治疗竹叶青蛇伤凝血障碍的作用。

Objective This study investigated the mechanism of Sheshang capsule regulating the blood coagulation disorders among patients bitten by Trimeresurus stejnegeri snake . Methods 70 cases of Trimeresurus stejnegeri snake envenoming patients which conform to the diagnostic criteria of the fire toxin syndrome were randomized into control group and therapy group by SPSS ,each of 35 cases .The basic treatments of the control group include wounds disinfecting ,intramuscular injection of 1500 u tetanus antitoxin ,conventional dose of antibiotics ,10 mg dexamethasone ,40 mg omeprazole and so on .Otherwise ,10 Jidesheng Sheyao tablets were given three times a day . The basic treatments of the therapy group were as same as the former and 5 Sheshang capsules were used three times a day in the group .Both two groups had a course of treatment of one week .The platelet count（PLT ） ,mean platelet volume（MPV） ,platelet distribution width（PDW） ,prothrombin time（PT ） ,thrombin time（TT ） ,activated partial thromboplastin time（APTT） ,fibrinogen（FIB） of the two groups were measured before and after treatment . Results There were no significant differences in TT ,PT ,APTT ,FIB ,PLT ,MPV and PDW between two groups before treatment（all P〉0.05） .After treatment ,the increases（differences） of FIB ,PLT ,MPV and PDW were more than the control group（P〈0.05 or P〈0.01） ,the decreases（differences） of TT ,PT and APTT in the treatment group were more than the control group（P〈0.01） . Conclusion The Sheshang capsule could treat coagulation disorders induced by the Trimeresurus stejnegeri snakebites through reducing the consumption of coagulation fac‐tor ,anti‐fibrinolysis and improving the hemostatic function of platelet .