140例竹叶青蛇咬伤患者的凝血功能分析

Analysis of coagulation function in 140 cases bitten by Trimeresurus stejnegeri

目的分析竹叶青蛇咬伤患者的凝血功能,了解其动态变化规律。方法收集并分析2017年1月至2021年12月我院住院确诊为竹叶青蛇咬伤患者的临床资料,比较竹叶青蛇咬伤患者治疗前后的凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、纤维蛋白降解产物(FDP)。结果140例竹叶青蛇咬伤患者的平均年龄为(62.17±12.56)岁,咬伤后平均入院时间为(6.59±3.45)h。140例患者治疗前的FDP、FIB、TT、APTT、PT、INR异常率分别为81.42%(114/140)、67.14%(94/140)、39.29%(55/140)、32.14%(45/140)、24.29%(34/140)、11.43%(16/140)。FIB和FDP最早出现异常,其中位时间为8 h,差异有统计学意义(P<0.01);FDP最早达到峰值,其中位时间为10 h,差异有统计学意义(P<0.01)。治疗后2 h,PT、APTT、FIB、FDP的异常率仍较高,其中FDP异常率最高为70%,INR及TT的异常率为0。随着治疗的进行,PT、INR、APTT、TT、FIB的异常率呈明显波动性,PT、INR、TT、FIB的异常率先上升后下降又再上升;APTT的异常率先上升后下降,再上升又下降;FDP的异常率在被咬伤2?h后逐渐上升,至16 h后开始下降。结论竹叶青蛇咬伤患者FDP异常率最高,INR异常率最低,FDP最早出现异常并最早达到高峰。与其他凝血功能指标对比,FDP具有灵敏性、精确性、稳定性更高的特点。

Objective To analyze the blood coagulation function in patients bitten by Trimeresurus stejnegeri and to understand its dynamic change rule.Methods The clinical data of patients diagnosed with Trimeresurus stejnegeri in our hospital from January 2017 to December 2021 were collected and analyzed.Prothrombin time(PT),international standardized ratio(INR)activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB),and fibrinogen degradation products(FDP)before and after treatment of bamboo leaf green snake bite patients were observed and analyzed.Results The average age of 140 patients bitten by Trimeresurus stejnegeri was(62.17±12.56)years old,and the mean admission time after bite was(6.59±3.45)h;The abnormal rates of FDP,FIB,TT,APTT,PT and INR were 81.42%(114/140),67.14%(94/140),39.29%(55/140),32.14%(45/140),24.29%(34/140)and 11.43%(16/140),respectively.FIB and FDP were the earliest abnormal,and the difference of 8 h was statistically significant(P<0.01);FDP reached the earliest peak at 10 h,and the difference was statistically significant(P<0.01).2 h after treatment,the abnormal rates of PT,APTT,FIB and FDP were still high,the highest rate of FDP was 70%,and the abnormal rates of INR and TT was 0.With the progress of treatment,the abnormal rate of PT,INR,APTT,TT,FIB showed obvious volatility,the abnormal rate of PT,INR,TT,FIB increased first,then decreased the then increased again;the abnormal rate of APTT increased first,then decreased,then increased and decreased again;while the abnormal rate of FDP gradually rising 2 h after bite and began decease 16 h after bite.Conclusion The highest abnormal rate is FDP,the lowest abnormal rate is INR,the earliest abnormal rate is FDP,and the highest abnormal rate is FDP.Compared with other indicators,FDP is more sensitive and accurate.