刺血拔罐改良局部伤口护理联合凉血解毒膏在竹叶青蛇咬伤患者中的应用效果

Application effect of modified local wound nursing of pricking and cupping combined with cooling blood and detoxicating ointment in patients bitten by Trimeresurus stejnegeri

目的 探讨刺血拔罐改良局部伤口护理联合凉血解毒膏对竹叶青蛇咬伤患者临床疗效的影响。方法 回顾性分析2019年8月至2022年1月北京中医药大学深圳医院(龙岗)急诊科收治的133例竹叶青蛇咬伤患者的一般资料,根据治疗方法的不同分为对照组(63例)和观察组(70例)。对照组患者采用常规护理和对症治疗,观察组患者在对照组干预方法的基础上采用刺血拔罐改良局部伤口护理联合凉血解毒膏治疗。比较2组患者的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血清淀粉样蛋白A(SAA)、超敏C反应蛋白(hs-CRP)、患肢周径差和视觉模拟评分法(VAS)评分。结果 2组在不同时间点的PT和APTT均有统计学差异(P均<0.05);与治疗前和治疗第1天比较,2组在治疗第3天和第7天的PT和APTT均延长(P均<0.05),且治疗第3天均长于第7天(P均<0.05);但2组的时间点与干预方法之间均无交互效应(P均>0.05)。2组在不同时间点的SAA、hs-CRP、患肢周径差和VAS评分均有统计学差异(P均<0.05),且随着治疗时间的延长均逐渐降低(P均<0.05);时间点与干预方法之间均存在交互效应(P均<0.05)。治疗的第1天、第3天和第7天,观察组的SAA、hs-CRP、患肢周径差和VAS评分均优于同期对照组(P均<0.05)。结论 刺血拔罐改良局部伤口护理结合凉血解毒膏治疗竹叶青蛇咬伤患者,可以减轻炎症反应、肿胀和疼痛程度。

Objective To explore the effect of modified local wound nursing of pricking and cupping combined with cooling blood and detoxicating ointment on the clinical efficacy of patients bitten by Trimeresurus stejnegeri.Methods A retrospective analysis was made on the general data of133 patients bitten by Trimeresurus stejnegeri from the Department of Emergency at Shenzhen Hospital,Beijing University of Chinese Medicine between August 2019 and January 2022.According to the different treatment methods,they were divided into a control group(63 cases)and an observation group(70 cases).The patients in the control group were treated with routine nursing and symptomatic treatment,while the patients in the observation group were treated with modified local wound nursing of pricking and cupping combined with cooling blood and detoxicating ointment on the basis of the intervention method of the control group.The prothrombin time(PT),activated partial thromboplastin time(APTT),serum amyloid A(SAA),high-sensitivity C-reactive protein(hs-CRP),circumference difference of the affected limb,and Visual Analogue Scale(VAS)scores were compared between the two groups.Results The PT and APTT of both groups at different time points were significantly different(allP<0.05).Compared with those before treatment and on the 1st day of treatment,the PT and APTT in both groups were prolonged on the3rd and7th day of treatment(allP<0.05),and the PT and APTT were longer on the3rd day than on the7th day(all P<0.05).There was no interaction between the time points and the intervention methods in the two groups(both P>0.05).The SAA,hs-CRP,circumference difference of the affected limb,and VAS scores at different time points were significantly different between the two groups(all P<0.05),and gradually decreased with the treatment time(all P<0.05).There were interactions between the time points and the intervention methods(all P<0.05).On the 1st,3rd,and 7th day of treatment,the SAA,hs-CRP,circumference difference of the affected limb,and VAS scores in the observation group were better than those in the control group(all P<0.05).Conclusion Modified local wound nursing of pricking and cupping combined with cooling blood and detoxicating ointment can reduce the inflammatory response,swelling,and pain of patients bitten by Trimeresurus stejnegeri.