抗蝮蛇毒血清与抗五步蛇毒血清在竹叶青蛇咬伤治疗中的应用

Application of Snake Antivenins and Agkistrodon Acutus Antivenin in the Treatment of Trimeresurus Stejnegeri Bite

目的:分析竹叶青蛇咬伤患者应用抗蝮蛇毒血清与抗五步蛇毒血清治疗的效果。方法:纳入2019年1月—2022年12月福建医科大学附属龙岩第一医院收治的126例竹叶青蛇咬伤患者作为研究对象,应用随机数表法分为抗蝮蛇组、抗五步蛇组和联合组三组,各42例。抗蝮蛇组给予抗蝮蛇毒血清治疗,抗五步蛇组给予抗五步蛇毒血清治疗,联合组给予抗蝮蛇毒血清与抗五步蛇毒血清联合治疗,比较三组康复情况及三组治疗前后血常规、炎症指标及凝血功能。结果:联合组患侧肢体肿胀消失时间、疼痛消失时间、住院时间短于抗蝮蛇组和抗五步蛇组,抗五步蛇组患侧肢体肿胀消失时间、疼痛消失时间和住院时间短于抗蝮蛇组,差异有统计学意义(P<0.05)。治疗后,三组红细胞、血红蛋白、白细胞计数、降钙素、C反应蛋白、血清淀粉样蛋白A、凝血酶原时间、凝血酶时间和纤维蛋白原较治疗前改善,差异有统计学意义(P<0.05),且联合组红细胞、血红蛋白和纤维蛋白原高于抗蝮蛇组和抗五步蛇组,白细胞计数、降钙素、C反应蛋白和血清淀粉样蛋白A低于抗蝮蛇组和抗五步蛇组,凝血酶原时间和凝血酶时间短于抗蝮蛇组和抗五步蛇组,抗五步蛇组红细胞、血红蛋白和纤维蛋白原高于抗蝮蛇组,抗五步蛇组白细胞计数、降钙素、C反应蛋白和血清淀粉样蛋白A低于抗蝮蛇组,抗五步蛇组凝血酶原时间和凝血酶时间短于抗蝮蛇组,差异有统计学意义(P<0.05)。结论:抗蝮蛇毒血清与抗五步蛇毒血清均可有效改善竹叶青蛇咬伤患者的血常规、炎症反应和凝血功能,其中抗五步蛇毒血清改善效果优于抗蝮蛇毒血清,两者联合可进一步增强临床疗效,加速康复进程,缩短症状改善时间和住院时间。

Objective:To analyze the effect of Snake Antivenins and Agkistrodon Acutus Antivenin in the treatment of trimeresurus stejnegeri bite.Method:A total of 126 patients with trimeresurus stejnegeri bite who admitted to the First Affiliated Hospital of Longyan,Fujian Medical University from January 2019 to December 2022 were included as the study objects,and they were divided into the anti-pit viper group,the anti-five-step snake group and the combined group,with 42 cases in each group.The anti-pit viper group was treated with Snake Antivenins,the anti-five-step snake group was treated with Agkistrodon Acutus Antivenin,and the combined group was treated with Snake Antivenins combined Agkistrodon Acutus Antivenin.The rehabilitation and the blood routine,inflammatory indexes and coagulation function before and after treatment among three groups were compared.Result:The swelling disappearance time of affected limb,pain disappearance time and hospitalization time in the combined group were shorter than those in the anti-pit viper group and the anti-five-step snake group,the swelling disappearance time of affected limb,pain disappearance time and hospitalization time in the anti-five-step snake group were shorter than those in the anti-pit viper group,and the differences were statistically significant(P<0.05).After treatment,the erythrocyte,hemoglobin,white blood cell count,calcitonin,C-reactive protein,serum amyloid A,prothrombin time,thrombin time and fibrinogen in three groups were significantly improved compared with those before treatment,and the differences were statistically significant(P<0.05),the erythrocyte,hemoglobin and fibrinogen in the combined group were higher than those in the anti-pit viper group and the anti-five-step snake group,the white blood cell count,calcitonin,C-reactive protein and serum amyloid A were lower than those in the anti-pit viper group and the anti-five-step snake group,the prothrombin time and thrombin time were shorter than those in the anti-pit viper group and the anti-five-step snake group,and the erythrocyte,hemoglobin and fibrinogen in the anti-five-step snake group were higher than those in the anti-pit viper group,the white blood cell count,calcitonin,C-reactive protein and serum amyloid A in the anti-five-step snake group were lower than those in the anti-pit viper group,and the prothrombin time and thrombin time in the anti-five-step snake group were shorter than those in the anti-pit viper group,the differences were statistically significant(P<0.05).Conclusion:Both Snake Antivenins and Agkistrodon Acutus Antivenin can effectively improve the blood routine,inflammatory response and coagulation function of patients bitten by trimeresurus stejnegeri,the improvement effect of Agkistrodon Acutus Antivenin is better than that of Snake Antivenins,the combination of two can further enhance the clinical efficacy,accelerate the rehabilitation process,and shorten the time of symptom improvement and hospitalization.