眼镜蛇咬伤的临床特点与院前急救策略分析

The clinical features and pre-hospital first aid strategies of patients with cobra bites：a retrospec-tive analysis of 115 cases

目的：分析眼镜蛇咬伤中毒临床特点，探讨不同的院前急救措施对眼镜蛇咬伤患者预后的影响。方法收集我院蛇伤中毒科2014-01～2016-01眼镜蛇咬伤患者115例临床数据资料进行回顾性分析。按就诊时间分为两组：A组（0 h≤就诊时间＜8 h）、B组（8 h≤就诊时间＜24 h），按是否行捆扎分为捆扎组50例与非捆扎组65例，按是否切开分为切开组52例与非切开组63例。患者入院后进行血清肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）及溃疡评分、肿胀评分、病情评分。并对结果进行统计学分析。结果①115例患者平均就诊时间10.1 h，最早l h，最晚24 h；植皮56例，未植皮59例，A组的重危型发生率低于B组；②捆扎组血清CK、溃疡评分、肿胀评分明显高于非捆扎组，两组比较差异有统计学意义（P＜0.01）；③切开组的血清CK、CK-MB、溃疡评分、肿胀评分、病情评分低于非切开组，两组比较差异有统计学意义（P＜0.05）。结论眼镜蛇咬伤短时间容易引起局部皮肤软组织坏死，早期切开排毒是最佳的预防措施。捆扎不当及就诊时间延长是加重局部组织坏死的危险因素。

Objective To summarize the characteristics of patients with cobra bite, and analyze the different pre-hospital emergency treatments effect on the prognosis of patients with cabra bite. Meth-ods A retrospective study was conducted in Affiliated Nanhua Hospital, Universty of South China from Jan 2014 to Jan 2016. A total of 115 patients bitten by cabra which admitted into Snake Bite and Toxico-sis Unit were included in the study based on inclusion criteria. There were two groups, A group（visit time〈8 h）and B group（visit time ≥ 8 h）, based on visit time. Data of the patients were collected and analyzed. They were divided into binding group and non-binding group according to pretreatment, and divided into incision group and non-incision group according to pre-treatment. Results ①The mean treatment time was 10.1 h, the earliest l h, the latest 24 h. Fifty-six cases were grafted. Skin graft rate was obviously higher in binding group（72%）than that in non-binding group（30.8%）（P〈0.001）; se-rum levels of CK and scores of ulcer, swelling were obviously higher in binding group than those in non-binding group（P〈0.05）. ②Serum levels of biochemical indices（CK, CK-MB）, clinical scores（ulcer score, swelling score, illness score）, were significantly higher in group A than those in group B（P〈0.05）. ③There were positive correlation between ulcer score and serum CK or CK-MB, respectively（r=0.778, 0.555）; positive correlation between illness score and serum CK and CK-MB were found after cor-relation analysis（r=0.740, 0.693 respectively）. Conclusion Cobra bite can cause local tissue necro-sis of patients in a short time, the rate of skin graft is high. Early incision detoxification can significantly improve prognosis of patients with cobra bite and can reduce the extent of tissue necrosis. Improper bind-ing and prolonged treatment are the independent risk factors of skin graft in patients with cobra bite.