重型蝰蛇咬伤救治1例

A case of treatment in Severe Viper Snakebites

目的探讨综合治疗在重症蝰蛇咬伤中的价值。方法回顾性分析1例重症蝰蛇咬伤患者的治疗。结果1例55岁男性患者因右手蝰蛇咬伤3h,于2018年9月10日9时入住安庆市第一人民医院急诊科。入院后患者右手肿胀逐渐加重,出现血尿及凝血功能障碍。9月12~14日,患者凝血酶原时间、活化部分凝血酶原时间、国际标准化比值、凝血酶时间及纤维蛋白原等指标均未检出。病程中给予局部针刺真空罐疗、抗蛇毒血清、季德胜蛇药片口服与外敷、输注纤维蛋白原及血浆、补液等综合治疗。9月15日起患肢肿胀逐渐好转、凝血功能逐渐恢复。9月20日出院。9月24日复查凝血功能正常。1个月后随访,右手无功能障碍。结论重型蝰蛇咬伤的救治应坚持综合治疗的原则,尽早给予真空拔罐排毒及足量抗蛇毒血清治疗。

Objective To discuss the value on comprehensive treatment in severe snakebite of viper.Methods The treatment of a patient with severe viper snakebite was retrospectively analyzed.Results A 55-year-old male patient was admitted to the emergency department of the First People's Hospital of Anqing at 9:00 on September 10,2018 because of a right-hand adder bite for 3 hours.After admission,the swelling of the right hand gradually aggravated,and hematuria and coagulation dysfunction appeared.The prothrombin time,activated partial thromboplastin time,international standardized ratio,thrombin time and fibrinogen of the patient were not detected from September 12 to 14.In the course of disease,comprehensive treatment including local needling vacuum cupping therapy,antivenom serum,fibrinogen and plasma,fluid infusion were given to the patient.From September 15,the swelling of affected limbs gradually improved and the coagulation function gradually recovered.The patient left hospital on September 20th.The coagulation function was normal on September 24 th.The right hand without dysfunction after follow-up of one month.Conclusion Comprehensive the treatment of heavy python bites should adhere to the principle of comprehensive treatment,vacuum cupping therapy and sufficient antivenin should be given as early as possible.