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目的研究多个小切口联合负压治疗对毒蛇咬伤后肿胀消退和炎症反应的影响。方法选择2015年4月至2016年7月我科收治的毒蛇咬伤患者29例,其中男性18例,女性11例,年龄18~70岁,用随机数字法将研究对象分为对照组和观察组(注册号:Chi CTR-TRC-14004189)。对照组采用传统综合治疗,观察组行患肢近端皮肤多个小切口手术后予以负压吸引,同时采用传统综合治疗。分别在治疗前(0 h),治疗后6、12、24、48、72 h 6个时间点,测量并计算患肢近端、中部、远端肢体周径与健侧对应部位肢体周径差值,同时测血清IL-6和TNF-α浓度,记录平均住院时间。结果不同时间下测量的观察组与对照组肢体周径差值差异有统计学意义,观察组小于对照组(P<0.05);在不同测量时间下对照组与观察组IL-6与TNF-α浓度差异有统计学意义(P<0.05),观察组低于对照组;两组平均住院时间差异有统计学意义(P=0.001),观察组少于对照组[观察组(5.43±1.07)d,对照组(7.67±1.95)d]。结论毒蛇咬伤后在传统综合治疗基础上采用小切口负压治疗可有效控制肿胀,加速肿胀消退,减轻全身炎症反应,缩短住院时间。
Objective To study the effect of multiple small incisions combined with negative pressure therapy on the subsidence and inflammatory response after poisonous snake bite. Methods From April 2015 to July 2016, 29 cases of snakebite patients were treated in our department, including 18 males and 11 females, aged from 18 to 70 years. The subjects were divided into control group and observation group by random number method Group (registration number: Chi CTR-TRC-14004189). In the control group, the traditional comprehensive treatment was adopted. In the observation group, multiple small incisions in the proximal skin of the affected limb were suctioned under negative pressure after operation, and the traditional comprehensive treatment was used. Respectively before treatment (0 h), 6,12,24,48,72 h after treatment at 6 time points, measurement and calculation of limb proximal, middle and distal limb circumference and contralateral limb corresponding body parts of the poor diameter Value, at the same time measure serum IL-6 and TNF-α concentration, record the average length of stay. Results The difference of limb circumference between observation group and control group measured at different time had statistical significance, the observation group was smaller than that of control group (P <0.05); IL-6 and TNF-α in control group and observation group at different time (P <0.05), the observation group was lower than the control group; the average length of stay in both groups was statistically significant (P = 0.001), the observation group was less than the control group [5.43 ± 1.07] d , Control group (7.67 ± 1.95) d]. Conclusion After the snake bite in the traditional comprehensive treatment based on the use of small incision negative pressure therapy can effectively control the swelling and accelerate swelling subsided to reduce the systemic inflammatory response and reduce hospitalization time.