积雪苷霜软膏治疗眼镜蛇咬伤局部创面疗效观察

Effect of asiaticoside cream in the treatment of cobra local bite wounds

目的观察积雪苷霜软膏治疗眼镜蛇咬伤创面的临床效果。方法选择2015年4月至2018年10月解放军第922医院收治的眼镜蛇咬伤患者44例为研究对象,根据蛇咬伤局部创面治疗方法分为观察组和对照组,每组22例。2组患者均给予局部切开排毒、局部封闭、抗蛇毒血清等常规治疗,在常规治疗基础上,对照组患者使用400 g·L^(-1)硫酸镁甘油纱布覆盖局部创面,观察组患者使用积雪苷霜软膏涂抹局部创面,直至创面愈合。每日连续观察创面变化情况,记录2组患者疼痛缓解时间、局部肿胀开始消退时间、局部肿胀完全消退时间、创面愈合时间及总疗程。2组患者分别于治疗第1、3、7天进行外周血常规检查,记录白细胞总数、中性粒细胞、淋巴细胞和单核细胞水平变化。2组患者于治疗第14天进行疗效判定。结果观察组患者疼痛缓解时间、局部肿胀开始消退时间、局部肿胀完全消退时间、创面愈合时间及总疗程均显著短于对照组(P<0.05)。与治疗第1天比较,2组患者治疗第3、7天外周血白细胞总数、中性粒细胞及淋巴细胞水平显著降低,单核细胞水平显著升高(P<0.05); 2组患者治疗第7天外周血白细胞总数、中性粒细胞及淋巴细胞水平显著低于治疗第3天(P<0.05),2组患者治疗第7天与治疗第3天单核细胞水平比较差异无统计学意义(P>0.05)。治疗第1天,2组患者外周血白细胞总数、中性粒细胞、淋巴细胞及单核细胞水平比较差异均无统计学意义(P>0.05);治疗第3天,观察组患者外周血白细胞总数、中性粒细胞及淋巴细胞水平显著低于对照组(P<0.05);治疗第7天,观察组患者外周血白细胞总数、中性粒细胞水平显著低于对照组(P<0.05); 2组患者治疗第7天淋巴细胞水平比较差异无统计学意义(P>0.05),2组患者治疗第3、7天单核细胞水平比较差异无统计学意义(P>0.05)。观察组和对照组患者治疗总有效率分别为95.45%(21/22)、86.36%(19/22),观察组患者治疗总有效率高于对照组(χ~2=3.601,P<0.05)。结论积雪苷霜软膏治疗眼镜蛇咬伤局部创面临床疗效确切,并可改善全身炎症反应。

Objective To observe the clinical effect of asiaticoside cream in treatment of cobra bite wounds. Methods Forty-four patients with cobra bite in the 922 nd Hospital of Chinese People′s Liberation Army from April2015 to October2018 were selected as research subjects.The patients were divided into observation group and control group according to the treatment method of snake bite wound,with22 cases in each group.The patients in the two groups were treated with routine treatment such as local incision detoxification,local blockade and antivenom serum.On the basis of routine treatment,the local wounds of patients in the control group were covered with400 g·L^-1 magnesium sulfate gauze,while the local wounds of patients in the observation group were smeared with asiaticoside cream until the wound healed.The changes of wound surface were observed continuously every day.The pain relief time, the time of local swelling beginning to subside,the time of complete subsidence of local swelling,the wound healing time and the total course of treatment were recorded.The blood routine examination was performed on the first,third and seventh day of treatment in the two groups,and the changes of the levels of total white blood cells,neutrophils,lymphocytes and monocytes were recorded.The curative effect of patients in the two groups was evaluated on the fourteenth day of treatment. Results The pain relief time,the time of local swelling beginning to subside,the time of complete subsidence of local swelling,the wound healing time and the total course of treatment in the observation group were significantly shorter than those in the control group( P <0.05).Compared with the first day of treatment,the levels of total white blood cells,neutrophils and lymphocytes were significantly decreased,and the level of monocyte was significantly increased on the third and seventh day of treatment in the two groups ( P <0.05).The levels of total total white blood cells, neutrophils and lymphocyte on the seventh day of treatment were significantly lower than those on the third day of treatment in the two groups ( P <0.05).There was no significant difference in the level of monocytes between the seventh day and the third day of treatment in the two groups ( P >0.05).There was no significant difference in the levels of total white blood cells,neutrophils, lymphocytes and monocytes between the two groups on the first day of treatment ( P >0.05).The levels of total white blood cells, neutrophils and lymphocytes in the observation group were significantly lower than those in the control group on the third day of treatment ( P <0.05).The levels of total white blood cells and neutrophils in the observation group were significantly lower than those in the control group on the seventh day of treatment ( P <0.05).There was no significant difference in the level of lymphocytes between the two groups on the seventh day of treatment ( P >0.05).There was no significant difference in the level of monocytes between the two groups on the third and seventh day of treatment ( P >0.05).The total effective rate in the observation group and the control group was 95.45%(21/22) and 86.36%(19/22 ),respectively.The total effective rate in the observation group was higher than that in the control group (χ2=3.601, P <0.05). Conclusion Asiaticoside cream is effective in treating cobra bite wounds,and can improve systemic inflammation.