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目的探讨中西医结合对蛇咬伤的临床救护方案。方法蛇蛟伤患者多数有一明显毒牙咬痕,呈两点并排状,确认为蛇咬伤后可先给予20片季德胜蛇药顿服再开展一系例救护措施。1.放血疗法:在牙痕处用3%双氧水冲洗和生理盐水反复冲洗,2%碘酊及75%酒清常规消毒。用手术刀做“+”字形扩张切口,使伤口附近毒液外流(但血循毒者切忌切排)。2.局部环封阻止毒素吸收,用20ml生理盐水+糜蛋白酶+普鲁卡因伤口近侧或外周做环封,其中糜蛋白酶亦有直接分解蛇素蛋白的作用。3.最关键的重要措施是静注抗蛇素血清和肌注破伤风疫苗,两者均需皮试阴性方可注射,如阳性者需经抗过敏治疗后减慢滴速,开始每分钟1ml,以后也不超过4ml/分。4.抗感染治疗,我院多采用克林霉素1.2g加生理盐水500ml静注三天抗感染治疗。5.中西医结合除开始顿服20片季德胜蛇药片外,另取20片碾成粉末调制成糊状敷于整个患肢肿胀处,并将放血点裸露置于低处以利渗血排毒,一日三次涂敷用至肿胀消失。6.嘱患者多饮水,有条件者给绿豆汤以利尿排毒,也可用冰敷于患处减缓毒素吸收,必要时遵医嘱给予甘露醇或速尿,加速毒素排出。结果治愈无后遗症和功能障碍。结论及早送正规医院注射抗蛇毒血清。
Objective To explore the clinical rescue plan of combining snakebite with traditional Chinese and western medicine. Methods Most of snake Jiao injury patients have a significant fangs bite marks, was two side-by-side shape, confirmed as snake bites can be given after 20 first quarter snake Dayton clothing snake Dayton clothing to carry out a series of ambulance measures. 1. Bloodletting therapy: Dental implants with 3% hydrogen peroxide flushing and saline repeatedly washed, 2% iodine and 75% liquor routine disinfection. Scalpel do “+ ” shape expansion incision, so that the venom wound near the outflow (but blood poisoning should not cut the row). 2. Local loop to stop the absorption of toxins, with 20ml saline + chymotrypsin + procaine wound proximal or peripheral ring seal, chymotrypsin also has a direct role in the decomposition of the snake protein. 3. The most important measure is intravenous injection of anti-snake serum and intramuscular injection of tetanus, both need skin test negative before injection, such as positive anti-allergy treatment by slowing drip rate, the beginning of 1ml per minute , No later than 4ml / min. 4. Anti-infective treatment, our hospital more with clindamycin 1.2g plus saline 500ml intravenous three days anti-infective treatment. 5. In addition to the beginning of Dayton Integrative Medicine Dayton 20 snake pill tablets, the other 20 into a powder grind into a paste applied to the swelling of the affected limbs, and bleeding points exposed at a low place to facilitate bleeding detoxification, a Apply three times daily until swelling disappears. 6. Zhu Huanzhe more water, the conditions for detoxification of mung bean soup to detoxification, ice can also be used in the affected area to slow the absorption of toxins, if necessary, given mannitol or furosemide to speed up the excretion of toxins. Results cured no sequelae and dysfunction. Conclusion Early regular hospital injection of anti-snake venom serum.