圆斑蝰蛇(Vipera russelli siamensis)咬伤引起严重肺出血的报告

Case Report:Severe Pulmonary Hemorrhage Causedby Snakebite of Vipera russelli siamensis

患者 :男 ,4 2岁 ,广西农民 ;2 0 0 3年 5月 2 5日下午 5时在工地捕捉 1条约 4 0 cm长蝰蛇时不慎被其咬伤 ,局部肿胀疼痛 ,下午 7时即转送来我院急诊。检查右手大鱼际可见牙痕 1个 ,渗血及皮下瘀血少许 ,肿至腕关节。牙龈出血 ,PT:>2 min (对照 11.9s) ;Fg:0 .0 g/L;尿隐血 ( )。第 2天 (伤后13h)觉胸闷、气紧、咳嗽、咯血 ,即给予查胸片 ,示右上、中肺可见模糊片状影。第 3天胸闷、气紧加重 ,出现两肺出血所致呼吸功能不全 ,复查胸片示病灶比前增多 ,右肺及左下肺可见斑片状边缘模糊阴影。咳嗽、气紧、咯血为鲜红色伴有少许血块 ,两肺可闻湿性罗音 ,心率 110次 /分 ,律整 ,血氧饱和度为 85%～ 90 %。经地塞米松、山茛菪碱、止血、抗感染等治疗 10天 ,症状体征消失 。

A peasant man who was bitten by a snake (about 40cm long) of Vipera russelli siamensis at Guangxi of China in 5pm,May 25,2003 Bleeding from one tooth mark in right hand with local swell and pain were found He was send on emergency room in 7pm Examination found the gum bleeding,PT was >2min and Fg was 0 0g/L Blood urine was appeared Second day ( 13 hours after bitten) he become chest close,respiratory difficult,and cough,emptysis X-ray showed the dark shadow at upper and middle part of right lung Three days after bite he was developed embitter in the symptoms and presented respiratory disfunction that caused by pulmonary hemorrhage X-ray showed the dark shadow at all part of right lung and lower part of left lung Wet rale cou ld hear from two lungs Heart rate was fast at 110 time/min The SaO 2 was decreased in 85%~90% After treatment with the dexamethason,654-2,bacteriophage,hemostasis and other medicines in 10 days of our hospital he was recovered