抗蝮蛇毒血清与抗五步蛇毒血清对竹叶青蛇咬伤患者凝血功能及炎症指标的影响

Effects of antivenin of Agkistrodon halys and antivenin of Deinagkistrodon acutus on coagulation function and inflammatory indexes in patients bitten by Trimeresurus stejnegeri snake

目的探讨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对凝血功能及炎症指标的影响。方法回顾性分析2022年1月至2023年12月我院收治的60例竹叶青蛇咬伤患者的临床资料,按照治疗方案不同分为对照组和观察组各30例。对照组给予抗蝮蛇毒血清治疗,观察组采用抗五步蛇毒血清治疗,比较两组患者的凝血功能指标[凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(DD)]、炎症指标[白细胞(WBC)、C反应蛋白(CRP)]水平及并发症发生情况。结果治疗后,观察组的PT、TT、APTT、DD指标水平均低于对照组,FIB水平高于对照组,差异均有统计学意义(均P<0.05)。治疗后,观察组的WBC、CRP水平均低于对照组,差异均有统计学意义(均P<0.05)。观察组发生休克、脏器出血、皮肤坏死、多器官功能障碍综合征等并发症发生率低于对照组,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治疗竹叶青蛇咬伤患者均具有一定效果,抗五步蛇毒血清在改善凝血功能指标、炎症指标方面的效果优于抗蝮蛇毒血清,且安全性高。

Objective To investigate the effects of antivenin of Agkistrodon halys and antivenin of Deinagkistrodon acutus on coagulation function and inflammatory indexes in patients bitten by Trimeresurus stenegeri snake.Methods The clinical data of 60 patients with Trimeresurus stenegeri snake bite treated in our hospital from January 2022 to December 2023 were retrospectively analyzed,and they were divided into control group and observation group with 30 cases in each group according to different treatment plans.The control group was treated with antivenin of Agkistrodon halys,and the observation group was treated with antivenin of Deinagkistrodon acutus.The levels of coagulation function index[prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT),fibrinogen(FIB),D dimer(DD)]and inflammation index[white blood cell(WBC),C-reactive protein(CRP)]were compared between the two groups,and the incidence of complications were compared between the two groups.Results After treatment,the level of PT,TT,APTT and DD indexes in observation group was lower than that in control group,and the level of FIB was higher than that in control group,with statistical significance(all P<0.05).After treatment,the levels of WBC and CRP in the observation group were lower than those in the control group,and the differences were statistically significant(all P<0.05).The incidence of complications such as shock,organ bleeding,skin necrosis and multiple organ dysfunction syndrome in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion Both antivenin of Agkistrodon halys and antivenin of Deinagkistrodon acutus are effective in the treatment of Trimeresurus stenegeri snake bite.antivenin of Deinagkistrodon acutus is better than antivenin of Agkistrodon halys in improving coagulation function index and inflammation index,and has high safety.