高压氧辅助抗蛇毒血清对早期蝮蛇咬伤中毒患者患肢肿胀情况、心肌酶谱、炎症因子水平改变的影响

Effects of hyperbaric oxygen⁃assisted antivenin on the swelling of affected limbs,changes of myocardial enzyme spectrum and inflammatory factors in patients with early belly viper bite poisoning

目的探究高压氧辅助抗蛇毒血清对早期蝮蛇咬伤中毒患者肿胀情况、心肌酶谱、炎症因子水平改变的影响。方法选取2021年5月至2023年1月在资阳市第一人民医院急诊治疗的早期蝮蛇咬伤中毒患者83例为研究对象,按随机数字表法分为观察组(n=41)和对照组(n=42),对照组给予抗蛇毒血清治疗,观察组在此基础上给予高压氧辅助治疗,观察两组临床疗效、肿胀消失时间、疼痛消失时间及住院时间,比较两组治疗前后患肢肿胀情况、视觉模拟评分法(VAS)评分、心肌酶谱[血清肌酸激酶(CK)、肌酸激酶同工酶MB(CK-MB)、心肌肌钙蛋白I(cTnI)]、炎症因子[C反应蛋白(CRP)、白细胞介素-6(IL-6)、降钙素原(PCT)]变化情况。结果治疗前,两组的患肢肿胀情况、VAS评分、CK、CK-MB、cTnI、CRP、IL-6及PCT水平比较,差异均无统计学意义(P>0.05);治疗后,观察组总有效率(97.56%)高于对照组(83.33%),差异有统计学意义(χ^(2)=4.822,P<0.05);观察组肿胀消失时间、疼痛消失时间及住院时间均短于对照组,差异有统计学意义(t=7.058、7.618、11.170,P<0.05);观察组肢体周径小于对照组,VAS评分均低于对照组,差异有统计学意义(t=14.397、6.791,P<0.05);观察组血清CK、CK-MB及cTnI水平均低于对照组,差异有统计学意义(t=16.524、4.734、5.740,P<0.05);观察组血清CRP、IL-6及PCT水平均低于对照组,差异有统计学意义(t=4.945、4.999、6.591,P<0.05)。结论高压氧辅助抗蛇毒血清可缓解早期蝮蛇咬伤中毒患者患肢肿胀情况,降低心肌损伤,抑制炎症反应,有效提高临床疗效。

Objective To explore the effects of hyperbaric oxygen-assisted antivenin on swelling of affected limbs,changes of myocardial enzymes and inflammatory factors in patients with early belly snake bite poisoning.Methods A total of 83 patients with early belly snake bite poisoning undergoing emergency treatment at Ziyang First Peoples Hospital were enrolled as the research subjects between May 2021 and Janu-ary 2023.They were divided into two groups:an observation group(n=41)and a control group(n=42)using the random number table method.The control group reveived treatment with antivenin,while the observation group received additional treatment with hyperbaric oxygen.The clinical effectiveness,time for swelling and pain to disappear,and length of hospitalization were observed in both groups.The changes in swelling of af-fected limbs,scores on the visual analogue scale(VAS),myocardial enzymes[creatine kinase(CK),cre-atine kinase isoenzyme MB(CK-MB),cardiac troponin I(cTnI)]and inflammatory factors[C-reactive pro-tein(CRP),interleukin-6(IL-6),procalcitonin(PCT)]before and after treatment were compared between the two groups.Results Before treatment,there were no significant differences in swelling of affected limbs,VAS score,CK,CK-MB,cTnI,CRP,IL-6 or PCT between the two groups(P>0.05).After treatment,the overall response rate of the observation group was higher than that of the control group(97.56%vs 83.33%,χ^(2)=4.822,P<0.05).The disappearance time of swelling and pain,as well as the hospitalization time were shorter in the observation group compared to the control group(t=7.058,7.618,11.170,P<0.05).The cir-cumference of limbs in the observation group was shorter than that in the control group,and the VAS score was lower than that in the control group(t=14.397,6.791,P<0.05).The levels of serum CK,CK-MB and cTnI in the observation group were lower than those in the control group(t=16.524,4.734,5.740,P<0.05),and the levels of CRP,IL-6 and PCT were also lower than those in the control group(t=4.945,4.999,6.591,P<0.05).Conclusion Hyperbaric oxygen-assisted antivenin can alleviate swelling of affected limbs,reduce myocardial injury,inhibit the inflammatory response and effectively improve the clinical curative effect in pa-tients with early belly snake bite poisoning.