VSD负压吸引排毒术在危重型毒蛇咬伤中的临床应用

Clinical application of VSD negative pressure aspiration and detoxification in severe snake bite

目的 探讨采用负压封闭引流（VSD）技术进行负压吸引排毒对危重型混合毒蛇咬伤患者的临床疗效.方法 采用前瞻性研究方法,选择2015年2月至2017年2月解放军第一七五医院急诊科收治的43例危重型混合毒蛇咬伤患者,按患肢是否早期切开减压并进行VSD治疗分为常规治疗组（20例）和VSD治疗组（23例）.常规治疗组给予抗蛇毒血清注射、季德胜蛇药片外用、伤口切开排毒等常规治疗;VSD治疗组在常规治疗基础上,于肿胀肢体近心端切开皮肤减压,持续进行VSD.比较两组咬伤创面感染率和局部皮肤坏死面积、C-反应蛋白（CRP）最高值、住院时间及伤残率.结果 43例患者术后随访 6-12个月,平均（10.3±1.4）个月,无死亡及截肢病例.与常规治疗组比较,VSD治疗组创面感染率明显降低〔8.7%（2/23）比40.0%（8/20）〕,局部皮肤坏死面积明显减小（cm2：4.2±0.8比6.0±1.3）,CRP最高值明显降低（mg/L：50.0±12.1比68.0±13.4）,住院时间明显缩短（d：11.7±2.9比17.7±4.9）,差异均有统计学意义（均P〈0.05）;两组致残率比较差异无统计学意义,但VSD治疗组较常规治疗组有降低趋势〔13.0%（3/23）比30.0%（6/20）〕.结论 采用综合用药、伤口切开排毒、肿胀肢体早期切开减压并进行VSD的策略治疗危重型混合毒蛇咬伤患者,有利于排出毒素、缓解肢体肿胀及炎症,减少局部组织坏死,促进肢体康复,缩短住院时间.

Objective To assess the clinical efficacy of vacuum sealing drainage （VSD） in the treatment of mixed poisonous snake bite. Methods A prospective study was conducted. Forty-three snake bite patients by mixed poisonous snakes admitted to Department of Emergency of the 175th Hospital of People＇s Liberation Army from February 2015 to February 2017 were enrolled. All patients were divided into routine treatment group （n = 20） and VSD treatment group （n = 23） according to whether early incision decompression and using the VSD technique. The patients in the routine treatment group were treated with injection of antivenoms, Jidesheng snake tablets external coating, and wound incision detoxification. Beside the routine treatments, patients in the VSD treatment group were treated with incision decompression and the VSD suction aspiration for the swelling limb. Bite wound infection rate, local skin necrosis area, maximum level of C-reactive protein （CRP）, length of hospital stay and disability rate were compared between the two groups. Results Forty-three patients were followed up for 6-12 months with average of （10.3±1.4） months postoperatively. There were no deaths in both groups. Compared with the routine treatment group, wound infection rate in the VSD treatment group was significantly lowered [8.7% （2/23） vs. 40.0% （8/20）], local skin necrosis area was significantly reduced （cm2： 4.2±0.8 vs. 6.0±1.3）, the maximum CRP was significantly lowered （mg/L： 50.0±12.1 vs. 68.0±13.4）, the hospitalization time was significantly shortened （days： 11.7±2.9 vs. 17.7±4.9）, and the difference above was statistically significant （all P 〈 0.05）. The disability rate of the VSD treatment group was lowered as compared with routine treatment group [13.0% （3/23） vs. 13.0% （6/20）] without statistically significant difference. Conclusion Early incision decompression and VSD pressure suction of the swelling limb associated with combination therapy of drugs is a reliable and effective method for severe snakebite, and can promote physical rehabilitation and shorten hospital stay.