竹叶青蛇咬伤中毒机制及临床研究新进展

Advances in the study of poisoning mechanism and coagulation function of Trimeresurus stejnegeri snakebite

竹叶青的毒素成分主要为血液毒素。被竹叶青蛇咬伤后的主要临床表现为出凝血功能障碍,其中最突出的表现是纤维蛋白原(Fib)严重消耗。根据2018年中国蛇伤救治专家共识,在治疗竹叶青蛇咬伤时,主要治疗措施有抗蛇毒血清的应用以及消肿止痛、预防破伤风、使用糖皮质激素等,并根据患者纤维蛋白原情况使用血制品如“新鲜冰冻血浆”及“冷沉淀”等补充人体内凝血物质以改善凝血功能。本文就国内外竹叶青蛇咬伤的中毒机制及临床研究相关文献进行复习并作一综述,为临床诊疗提供参考。

Trimeresurus stejnegeri is one of the most common venomous snakes in China.As bitten by the Trimeresurus stejnegeri,the main manifestation is blood coagulation dysfunction,and the most prominent manifestation is the serious consumption of fibrinogen.According to the"2018 expert consensus on the treatment of snake bite in China",the main treatment measures include the use of antivenom serum,detumescence and pain relief,prevention of tetanus,use of glucocorticoids,etc.Due to the serious consumption of fibrinogen in patients bitten by Trimeresurus stejnegeri,blood products such as"fresh frozen plasma(FFP)"and"cryoprecipitation"should be used to supplement coagulation factors.However,how to accurately evaluate the prognosis and treatment effect of patients after treatment is still questionable.In this paper,we reviewed and summarized the literatures on the poisoning mechanism and coagulation function of the snake bite at home and abroad.