早期二期清创对遏制蛇咬伤患者出血倾向中疗效观察

Clinical observation of early andⅡstage debridement in treatment of the bleeding tendency of snakebite patients

目的:探究早期二期清创对遏制蛇咬伤患者出血倾向的临床疗效。方法:选取我科室2016年3~10月收治的明确蛇毒种类的72例手指咬伤患者作为研究对象,根据毒蛇种类和入院先后顺序将患者随机分成甲、乙、丙、丁4组。通过比较患者关节肿胀情况、血小板减少情况、皮下紫癜情况以及伤口愈合情况分析出血倾向及临床疗效。结果:47例烙铁头蛇咬伤、25例蝮蛇咬伤患者中无论是否进行二期清创处理,其患肢病情演变情况(腕关节肿胀、肘关节肿胀、肘上10cm肿胀、血小板减少、紫癜)比较差异均无统计学意义;烙铁头蛇咬伤患者出血倾向发生率较蝮蛇高(均P<0.05);无论何种蛇伤,进行早期二期清创处理的患者,伤口消肿程度轻于未进行二期清创的患者,但愈合时间会延长,差异均有统计学意义(均P<0.05)。结论:蛇毒素种类是导致血小板消耗、凝血功能障碍的直接因素,二期清创不能遏制蛇毒素体内扩散和减少对组织的破坏但可以有效地减轻蛇毒对肌体损伤。

Objective：To explore the clinical effect of early andⅡ stage debridement in treating bleeding tendency of snakebite patients.Method：Seventy-two patients with finger bitten by explicitly snake venom types admitted in our department in March 2016 to October were selected as the research object.The patients were randomly divided into a,b,c,d four groups according to the snake species.The tendency of bleeding and clinical efficacy were analyzed by comparing the swelling of the patients,thrombocytopenia,subcutaneous purpura and wound healing.Result：No difference in the incidence of limb hemorrhage was found in 47 cases of iron head snake bite.There was no significant difference in the incidence of the onset of limb bleeding in 25 cases of viper bite（P〈0.05）.The rate of hemorrhage in patients with soldering iron head bites was significantly higher（P〈0.05）.There were 47 cases of welding head snake bites,25 patients bitten by agkistrodon halys.The difference had no difference in the limb condition evolution（wrist joint swelling,elbow joint swelling,10 cm elbow swelling,thrombocytopenia purpura）.The incidence of hemorrhage in patients with soldering iron head bites was higher than that of viper（P〈0.05）.No matter what kind of snake wound,wound swelling in patients of early andⅡ stage debridement treatment was less than patients who were not inⅡ-stage debridement,but healing time prolongs,and the differences were statistically significant（P〈0.05）.Conclusion：Snake poison kinds of platelet consumption,blood coagulation dysfunction is direct factors,cannot achieve contain venom spread in ferriteⅡ-stage debridement and reduce the damage to the organization but can effectively reduce the snake venom on the body damage.