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目的:探究早期二期清创对遏制蛇咬伤患者出血倾向的临床疗效。方法:选取我科室2016年3~10月收治的明确蛇毒种类的72例手指咬伤患者作为研究对象,根据毒蛇种类和入院先后顺序将患者随机分成甲、乙、丙、丁4组。通过比较患者关节肿胀情况、血小板减少情况、皮下紫癜情况以及伤口愈合情况分析出血倾向及临床疗效。结果:47例烙铁头蛇咬伤、25例蝮蛇咬伤患者中无论是否进行二期清创处理,其患肢病情演变情况(腕关节肿胀、肘关节肿胀、肘上10cm肿胀、血小板减少、紫癜)比较差异均无统计学意义;烙铁头蛇咬伤患者出血倾向发生率较蝮蛇高(均P<0.05);无论何种蛇伤,进行早期二期清创处理的患者,伤口消肿程度轻于未进行二期清创的患者,但愈合时间会延长,差异均有统计学意义(均P<0.05)。结论:蛇毒素种类是导致血小板消耗、凝血功能障碍的直接因素,二期清创不能遏制蛇毒素体内扩散和减少对组织的破坏但可以有效地减轻蛇毒对肌体损伤。
Objective: To investigate the clinical efficacy of early debridement and secondary debridement to prevent bleeding in patients with snake bites. Methods: Seventy - two patients with finger bites who were admitted to our department from March to October in 2016 were enrolled in this study. Patients were randomly divided into four groups according to the type of snake and the order of admission. Hemorrhagic tendency and clinical efficacy were analyzed by comparing swollen joints, thrombocytopenia, subcutaneous purpura, and wound healing. Results: In the 47 cases of bitten snakebite, 25 cases of viper snake bites regardless of whether the two debridement treatment, the limb limbs evolution (swelling of the wrist, elbow swelling, elbow swelling on the 10cm, thrombocytopenia, Purpura). There was no significant difference in the bleeding tendency among the patients with bitten snake bite (all P <0.05). No matter what kind of snakebite, the patients with early stage II debridement had more wounds The degree of debridement was lower than that of the patients who did not undergo debridement in the second stage, but the healing time would be longer, the differences were statistically significant (both P <0.05). CONCLUSION: The species of snake toxin is the direct factor leading to platelet consumption and coagulation dysfunction. The second debridement can not restrain the in vivo diffusion of snake toxin and reduce the damage to the tissue, but can effectively reduce the injury of snake venom to the body.