清毒百炎消外敷对蝮蛇咬伤患肢肿痛及血液指标的影响

Impact of using Qingdubaiyanxiao external application on limb swelling and pain and related blood indexes of patients with Agkistrodon halys bite injury

目的观察清毒百炎消外敷对蝮蛇咬伤患者肢体肿痛的疗效及相关血液指标的影响。方法选择九江市第一人民医院2018年7月1日至2021年6月30日收治的281例蝮蛇咬伤存活患者作为研究对象。根据治疗方案不同将患者分为血清组〔92例,静脉滴注(静滴)抗蝮蛇毒血清〕、蛇药组(96例,清毒百炎消外敷)及联合治疗组(93例,静滴抗蝮蛇毒血清联合清毒百炎消外敷),其余治疗方案3组均相同。比较3组治疗前和治疗后2、3、5、7 d患肢肿痛程度以及治疗后3 d、7 d相关血液指标的差异。结果3组治疗5 d开始患肢肿胀程度均显著减轻,蛇药组和联合治疗组中重度肿胀发生率均较血清组明显降低〔17.7%(17/96)、12.9%(12/93)比40.2%(37/92),均P<0.05〕;肢体疼痛评分持续降低,治疗7 d达最低水平,蛇药组和联合治疗组明显低于血清组〔分:0.00(0.00,1.00)、0.00(0.00,0.00)比1.00(0.00,1.00),均P<0.05〕。随时间延长,3组治疗后丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)均呈先升高后降低的趋势,于治疗3 d达到峰值,治疗后7 d降低,且蛇药组和联合治疗组ALT、AST、CK、CK-MB均明显低于血清组〔ALT(U/L):20.50(13.53,41.00)、20.80(15.50,29.60)比25.40(20.63,74.60),AST(U/L):24.15(19.38,35.90)、24.00(20.00,32.15)比27.35(21.23,80.18),CK(U/L):126.50(103.50,236.00)、122.00(102.00,161.00)比194.00(110.50,408.50),CK-MB(U/L):16.00(13.00,23.00)、15.00(13.00,20.00)比20.00(14.00,31.00),均P<0.05〕,而蛇药组和联合治疗组上述指标比较差异均无统计学意义(均P>0.05)。3组间血小板计数(PLT)、血肌酐(SCr)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)比较差异均无统计学意义(均P>0.05)。联合治疗组和蛇药组住院时间均较血清组明显缩短〔d:7(5,8)、7(6,8)比8(7,8),均P<0.05〕,日住院费用较血清组明显减少〔万元:0.93(0.73,1.14),1.00(0.85,1.16)比1.15(1.01,1.33),均P<0.05〕。结论清毒百炎消外敷治疗可显著缓解蝮蛇咬伤患者的肢体肿痛,降低转氨酶及心肌酶学水平,减少住院时间及住院费用,具有良好的临床疗效。

Objective To analyze the curative effect of Qingdubaiyanxiao external application in the treatment of injured limbs in patients with Agkistrodon halys bite with swelling and pain and its effect on the related blood indexes.Methods Two hundred and eighty-one surviving patients bitten by Agkistrodon halys and admitted to Jiujiang NO.1 People's Hospital from July 1,2018 to June 30,2021 were selected as the research objects.According to the treatment protocols,they were divided into three groups:serum group(92 cases,using intravenous drip of agkistrodon halys antivenin),snake medicine group(96 cases,Qingdubaiyanxiao external application)and combined treatment group(93 cases,intravenous drip infusion of agkistrodon halys antivenin and Qingdubaiyanxiao external application),the other treatment protocols were the same in the three groups.The differences in degrees of swelling and pain of injured limbs between before treatment on admission and the 2nd,3rd,5th,7th day after treatment and the levels of related blood indexes between before treatment on admission and the 3rd,7th day after treatment were compared among the three groups.Results Beginning from 5nd days of treatment,the degrees of swelling of affected limbs was significantly reduced,and the incidence of moderate to severe swelling in snake medicine group and combined treatment group was significantly lower than that in serum group[17.7%(17/96),12.9%(12/93)vs.40.2%(37/92),both P<0.05].Limb pain score decreased continuously and reached the lowest level after 7nd day of treatment,pain scores in snake medicine group and combined treatment group were significantly lower than in serum group[0.00(0.00,1.00),0.00(0.00,0.00)vs.1.00(0.00,1.00),both P<0.05].With prolongation of time,the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),creatine kinase(CK)and creatine kinase isoenzyme MB(CK-MB)isoenzyme all showed the trend of increasing first and then decreasing,with the peak on the 3rd day after treatment and then decline occurred on the 7th day after treatment.Furthermore,the levels of ALT,AST,CK and CK-MB in the snake medicine group and the combined treatment group all obviously lower than those in the serum group[ALT(U/L):20.50(13.53,41.00),20.80(15.50,29.60)vs.25.40(20.63,74.60),AST(U/L):24.15(19.38,35.90),24.00(20.00,32.15)vs.27.35(21.23,80.18),CK(U/L):126.50(103.50,236.00),122.00(102.00,161.00)vs.194.00(110.50,408.50),CK-MB(U/L):16.00(13.00,23.00),15.00(13.00,20.00)vs.20.00(14.00,31.00),all P<0.05],but the levels of the above blood indicators were of no statistical significant differences between the snake medicine group and the combined treatment group(all P>0.05).The platelet count(PLT),serum creatinine(SCr),prothrombin time(PT)and activated partial thromboplastin time(APTT)had no obvious statistical significant differences among the three groups(all P>0.05).Compared with the serum group,the average lengthes of hospital stay in the combined treatment group and the snake medicine group were obviously shortened[days:7(5,8),7(6,8)vs.8(7,8),both P<0.05],and the total costs of hospitalization were obviously reduced[ten thousand yuan:0.93(0.73,1.14),1.00(0.85,1.16)vs.1.15(1.01,1.33),both P<0.05].Conclusion Qingdubaiyanxiao external application can significantly alleviate the limb swelling and pain of patients with Agkistrodon halys bite injury,reduce the levels of transaminase and myocardial enzymes,decrease the average length of hospital stay and cost of hospitalization,thus it has a good clinical effect.