低分子肝素钠早期抗凝辅助治疗在重型和危重型竹叶青蛇咬伤患者中的应用

Application of low-molecular-weight heparin sodium in early anticoagulant adjuvant therapy in patients with severe and critical green snake bites

目的探究低分子肝素钠早期抗凝辅助治疗在重型和危重型竹叶青蛇咬伤患者中的应用价值以及临床疗效。方法选取2018年2月—2021年5月在联勤保障部队第910医院收治的88例被竹叶青蛇咬伤的患者,根据随机数字表法分为观察组和对照组,其中对照组采用常规治疗以及抗蛇毒血清治疗,观察组在对照组的基础上联合应用低分子肝素钠治疗,每组44例,观察两组患者的临床治疗效果,凝血指标以及肝肾功能等。结果观察组患者治愈人数23例(52.27%),总有效率为93.18%;对照组治愈人数15例(34.09%),总有效率为79.55%;观察组总有效率明显多于对照组(P<0.05)。治疗前,两组患者TT、APTT及PT的含量相比较差异无统计学意义;经治疗后,各指标出现明显好转,并且观察组改善效果明显优于对照组(P<0.05)。治疗前,两组患者肾损伤相关因子Scr、pNGAL、uNGAL含量相比较差异无统计学意义;经治疗后,各指标出现明显好转,并且观察组改善效果明显优于对照组(P<0.05)。治疗前,两组患者肝肾功能指标AST、ALT、Cr以及BUN含量相比较差异无统计学意义。经治疗后,各指标出现明显好转,并且观察组改善效果明显优于对照组(P<0.05)。两组患者治疗后,观察组总并发症发生率4.55%,对照组总并发症发生率18.18%,观察组并发症发生率明显低于对照组(P<0.05)。结论重型和危重型竹叶青蛇咬伤患者早期应用低分子肝素钠抗凝辅助治疗有助于提高患者的临床治疗效果,可以促进凝血指标以及肝肾功能的康复,减少并发症发生率,值得临床推广。

Objective To explore the application value and clinical efficacy of low-molecular-weight heparin sodium in early anticoagulant adjuvant therapy in patients with severe and critical green snake bites.Methods A total of 88 patients who were bitten by green bamboo snakes in our hospital from February 2018 to May 2021 were selected and divided into observation group and control group according to the random number table method.The control group received conventional treatment and antivenom for treatment,the observation group was treated with low-molecular-weight heparin sodium on the basis of the control group,with 44 cases in each group.The clinical treatment effects,blood coagulation indexes,liver and kidney functions of the two groups were observed.Results 23 patients in the observation group were cured(52.27%),with a total effective rate of 93.18%;15 patients in the control group were cured(34.09%),with a total effective rate of 79.55%;the total effective rate in the observation group was significantly higher than that of the control group(P<0.05).Before treatment,there was no significant difference in the contents of TT,APTT and PT between the two groups of patients;after treatment,the indicators showed a significant improvement,and the improvement effect of the observation group was significantly better than that of the control group(P<0.05).Before treatment,there was no significant difference in the contents of renal injury-related factors Scr,pNGAL,and uNGAL between the two groups of patients;after treatment,the indicators improved significantly,and the improvement effect of the observation group was significantly better than that of the control group(P<0.05).Before treatment,there was no significant difference in the contents of liver and kidney function indexes AST,ALT,Cr and BUN between the two groups of patients.After treatment,the indexes improved significantly,and the improvement effect of the observation group was significantly better than that of the control group(P<0.05).After treatment of the two groups of patients,the total complication rate of the observation group was 4.55%,the total complication rate of the control group was 18.18%,and the complication rate of the observation group was significantly lower than that of the control group(P<0.05).Conclusion The early application of low molecular weight heparin sodium anticoagulation adjuvant therapy in severe and critically ill patients with Bamboo leaf snake bite can help improve the clinical treatment effect of patients,promote the recovery of coagulation indexes and liver and kidney functions,and reduce the incidence of complications,which is worthy of clinical promotion.