持续中药湿润箍围疗法治疗毒蛇咬伤的效果评价

Effect of continuous moist therapy with Chinese medicine in treating snake bite

目的前瞻性研究毒蛇咬伤后两种不同的中药(季德胜蛇药片)外敷疗法,并评价其临床效果。方法 2015年1月—2017年12月,重庆市长寿区人民医院收治120例毒蛇咬伤患者,根据患者对蛇的描述及检查伤口确诊。其中男性68例,女性52例,平均年龄(53. 45±3. 24)岁;受伤至入院时间为(7. 18±2. 32) h;被咬伤部位分别为下肢87例,上肢33例,均为单处咬伤。患者随机分成两组各60例,一组采用季德胜蛇药辗碎粉末制成糊状外敷,24h保持近端肿胀肢体湿润(湿润组);一组采用季德胜蛇药辗碎粉末制成糊状外敷,但自然干燥后刮下药末后继续外敷(干燥组),两组全身治疗及局部清创方法相同。在患者入院后第0、1、3、5、7天各时相点密切观察,入院时(0d)观察1次,以后各时相点均在上午10∶00进行观察:(1)外敷药前后生命体征变化:包括体温、脉搏、呼吸、血压;(2)外敷药后全身及局部的毒副作用观察,包括局部有无过敏反应,疼痛及肿胀有无加重,有无搔痒、皮肤发红、皮温增加等现象。结果两种涂抹方法在观察的各时相点上,对患者生命体征变化无影响,无发烧及血象增高,无腹痛、恶心、呕吐等胃肠道症状,对心、肝、肾、肺功能无影响,局部无搔痒、皮疹、红肿加重等毒副作用;在各时相点上,均能减轻伤肢的肿胀和疼痛,但持续湿润箍围外敷疗法的作用要强于自然干燥外敷疗法;湿润组较干燥组能明显地减轻伤肢疼痛(P <0. 05),缩短肢体肿胀的时间和住院时间(P <0. 05),减少医疗费用。结论毒蛇咬伤后持续湿润箍围方法较传统的自然干燥外敷疗法,可以明显减轻患者的局部疼痛、肿胀等症状,缩短住院时间,值得在临床中推广应用。

Objective To prospectively study and evaluate the clinical effect of two kinds of external use of traditional Chinese medicine(Ji Desheng snake pill)for treating snake bite.Methods From Jan.2015to Dec.2017,120patients with snake bites were admitted to the People s Hospital of Changshou District of Chongqing.There were68males and52females,with an average age of(53.45±3.24)years.The time from injury to admission was(7.18±2.32)h.The bites were distributed in lower limbs in87cases and upper limbs in33cases,all of which were single bites.The patients were randomly divided into wet and drying group,with60cases in each group.Patients in the wet group were externally applied with paste-like Ji Desheng snake medicine powder,and the proximal limbs were kept moistened for24hours;while patients in the drying group were applied with the paste-like Ji Desheng snake medicine powder,with natural drying.The systemic treatment and local debridement methods were the same in both groups.Patients were closely observed on the0th,1st,3rd,5th,and7th day after admitted to the hospital:(1)changes in vital signs including body temperature,pulse,respiration,blood pressure were observed before and after external application;(2)systemic and local toxic side effects were observed after topical application,including local allergic reactions,pain or swelling,aggravation,skin redness,skin temperature increase.Results The two methods had no effect on the changes of vital signs,and no symptoms such as fever,increased blood picture,abdominal pain,nausea or vomiting,and had no effect on heart,liver,kidney and lung function.No toxic side effects such as local itch,rash,redness was observed.Both can alleviate the swelling and pain of the injured limb,but the effect of continuous moistening method was stronger than natural drying method,which could significantly alleviate the pain of the injured limb,the swelling of the limb,and shorten the hospitalization(P<0.05)and the medical costs.Conclusion The effect of continuous moistening method is stronger than natural drying method,which can significantly alleviate the pain of the injured limb and the swelling of the limb,and shorten the hospitalization.It is worthy of clinical promotion.