153例套式封闭疗法在北方蝮蛇咬伤治疗中的效果观察研究及文献复习

Observational study and literature review of 153 cases of occlusive treatment of Agkistrodon pit viper bite

目的:观察套式封闭疗法在北方蝮蛇咬伤治疗中的效果。方法:选择解放军总医院第四医学中心急诊科2020年10月—2023年9月收治的蝮蛇咬伤患者153例,根据患者在传统治疗的基础上有无接受套式封闭疗法分为治疗组(70例)及对照组(83例),并在就诊时及就诊后24h先后采集静脉血行凝血功能指标[血小板计数(platelet,PLT)、血浆凝血酶原时间(prothrombintime,PT)、活化部分凝血活酶时间(activatedpartialthromboplastintime,APTT)、纤维蛋白原浓度(fibrinogen,FIB)]及炎症指标[白细胞(whitebloodcell,WBC)计数、C反应蛋白(C-reactiveprotein,CRP)、白介素-6(interleukin-6,IL-6)]检查,分别记录视觉模拟评分(visualanalogue scale,VAS)并测量患肢最大周径。结果:两组患者的基线资料除受伤部位分布外均差异无统计学意义(P>0.05)。与入科时相比,治疗组入科治疗24h后在凝血指标(PTL、PT、APTT)、CRP、VAS评分及患者最大周径方面均显著恢复,差异有统计学意义(P<0.05);治疗组在PT、APTT、CRP、VAS评分及患者最大周径改善方面均显著优于对照组,差异有统计学意义(P<0.05)。结论:在传统治疗方法的基础上,辅以局部套式封闭疗法,可以改善患者的凝血功能、炎症水平、疼痛感并促进患肢肿胀程度方面的恢复。

Objective:To evaluate the effect of circumferential block therapy on Agksitrodon pit viper bite.Methods:A total of 153 patients with Agksitrodon bites admitted to our department from October,2020 to September,2023 were enrolled and divided into the treatment group(accepted circumferential block therapy on the base of standard treatment,n=70)and the control group(only accepted the standard therapy,n=83).Venous blood was collected at the time of treatment and 24 hours after treatment to measure the coagulation function indexes(PLT,PT,APTT,FIB)and inflammatory indicators(WBC,CRP and IL-6),and the VAS and max circumference of the injured limbs were recorded.Results:There were no significant difference in baseline data between the two groups except the distribution of injury sites.After 24 hours of treatment,blood coagulation index(PTL,PT,APTT),CRP,VAS score and maximum circumference of patients in the treatment group were significantly recovered compared with those at admission(P<0.05);PT,APTT,CRP,VAS score and maximum circumference of patients in the treatment group were significantly better than those in the control group(P<0.05).Conclusion:Standard therapy combined with the circumferential block therapy could improve blood clotting function,reduce inflammation levels,relieve pain and promote recovery of swelling degree of the affected limbs.