摘要
目的探讨低分子肝素钠联合抗蛇毒血清治疗重型和危重型竹叶青蛇咬伤的临床疗效。方法回顾性分析2017年3月至2019年5月厦门大学附属东南医院急诊科收治的48例重型和危重型竹叶青蛇咬伤患者的临床资料。在给患者早期注射抗蛇毒血清、季德胜蛇药片内服加外涂以及伤口切开排毒等治疗基础上,根据是否应用低分子肝素钠抗凝治疗分为肝素治疗组和非肝素治疗组。比较两组患者的性别、年龄、临床分型、伤肢肿胀程度、凝血功能指标变化、皮肤黏膜或消化道出血情况、输血情况、咬伤局部症状、住院时间及预后。结果两组患者性别、年龄、临床分型、伤肢肿胀程度等一般资料比较差异均无统计学意义。治疗3 d时,肝素治疗组血小板计数(PLT)明显高于非肝素治疗组〔×109/L:210.0(160.0,252.0)比136.0(104.0,198.5),P<0.05〕;而两组凝血四项检测结果比较差异无统计学意义。治疗6 d时,肝素治疗组血浆凝血酶时间(TT)较3 d时明显缩短〔s:30.3(20.4,37.0)比34.7(24.0,73.4),P<0.05〕,且纤维蛋白原(FIB)明显高于非肝素治疗组〔g/L:0.60(0.31,1.07)比0.20(0.14,0.60),P<0.01〕。肝素治疗组治疗期间出血发生率明显低于非肝素治疗组〔21.7%(5/23)比64.0%(16/25),P<0.01〕;肝素与非肝素治疗组分别有11例和18例患者接受输血治疗及补充凝血酶原复合物。肝素与非肝素治疗组住院时间比较差异无统计学意义(d:6.91±1.92比7.48±2.27,P>0.05)。两组患者治疗后随访1周至1个月,均无死亡及局部皮肤软组织坏死病例。结论对于重型和危重型竹叶青蛇咬伤患者,在注射抗蛇毒血清、季德胜蛇药片内服加外涂以及伤口切开排毒等基础上,早期应用低分子肝素钠抗凝等综合治疗,有利于肢体肿胀及炎症消退,减少输血,促进凝血功能恢复,缩短住院时间。
Objective To investigate the clinical effect of low molecular weight heparin sodium combined with antivenin in the treatment of severe and critical bite by Trimeresurus stejnegeri.Methods The clinical data of 48 patients with severe or critical bite by Trimeresurus stejnegeri admitted to emergency department of Southeast Hospital Affiliated to Xiamen University from March 2017 to May 2019 were retrospectively analyzed.On the basis of early treatment of antivenom serum,internal administration and external application of Jidesheng snake tablet,and wound incision and detoxification,the patients were divided into heparin treatment group and non-heparin treatment group according to whether the low molecular heparin sodium was used or not.The patients in the two groups were compared in terms of gender,age,clinical classification,swelling degree of injured limbs,change of coagulation function index,bleeding of skin,mucous membrane or digestive tract,blood transfusion,local symptoms of bite,length of hospital stay and prognosis.Results There was no significant difference in terms of gender,age,clinical classification or swelling degree of injured limbs between the two groups.On the 3rd day of treatment,the platelet count(PLT)in the heparin treatment group was significantly higher than that in the non-heparin treatment group[×109/L:210.0(160.0,252.0)vs.136.0(104.0,198.5),P<0.05].However,there was no significant difference in the four coagulation test results between the two groups.On the 6th day of treatment,the plasma thrombin time(TT)in the heparin treatment group was significantly shorter than that on the 3rd day of treatment[s:30.3(20.4,37.0)vs.34.7(24.0,73.4),P<0.05],and the fibrinogen(FIB)in the heparin treatment group was significantly higher than that in the non-heparin treatment group[g/L:0.60(0.31,1.07)vs.0.20(0.14,0.60),P<0.01].The incidence of bleeding in the heparin treatment group was significantly lower than that in the non-heparin treatment group[21.7%(5/23)vs.64.0%(16/25),P<0.01];11 patients in the heparin treatment group and 18 patients in the non-heparin treatment group received blood transfusion and prothrombin complex supplement respectively.There was no significant difference in the length of hospital stay between the heparin group and non-heparin treatment group(days:6.91±1.92 vs.7.48±2.27,P>0.05).The patients in both groups were followed up for 1 week to 1 month after treatment,and no death or local necrosis of skin and soft tissue was found.Conclusions For the patients with severe and critical bite by Trimeresurus stejnegeri,on the basis of injection of antivenom serum,internal administration and external application of Jidesheng snake tablet,and wound incision and detoxification,early application of low molecular weight heparin sodium anticoagulation and other comprehensive treatment is helpful to improve limb swelling and inflammation,reduce blood transfusion,promote the recovery of coagulation function,and shorten the length of hospitalization.
作者
郑志鹏
郁毅刚
吴燕生
郑泽源
林庆斌
刘美玲
曾庆铨
Zheng Zhipeng;Yu Yigang;Wu Yansheng;Zheng Zeyuan;Lin Qingbin;Liu Meiling;Zeng Qingquan(Department of Emergency,Southeast Hospital Affiliated to Xiamen University,Zhangzhou 363000,Fujian,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2020年第5期601-604,共4页
Chinese Critical Care Medicine
基金
军队后勤科研重大项目(BLB18J006)。
关键词
低分子肝素钠
抗蝮蛇血清
出凝血时间
竹叶青蛇咬伤
Low molecular weight heparin sodium
Antiviper serum
Bleeding time and coagulation time
Bite by Trimeresurus stejnegeri
作者简介
通信作者:曾庆铨,Email:diyzeng@163.com。
