不同劑量激素治療毒蛇咬傷后肢體腫脹的臨床觀察

李珍　王海華　章锃瑜

[摘要] 目的 研究不同劑量的激素治療毒蛇咬傷后肢體腫脹的療效。 方法 選擇2014年5月～2017年9月期間我院急診科收錄的267例毒蛇咬傷病例，予常規切開傷口排毒、全身靜滴抗蛇毒血清治療，依據傷肢腫脹程度的不同將267例患者分為輕度、中度、重度三組，相同肢腫程度的患者內部隨機分成對照組和實驗組，采用不同劑量的地塞米松治療，對照組地塞米松采用常規劑量10 mg，實驗組采用較大劑量20 mg，比較兩組患者的癥狀消褪時間、住院時間。 結果 毒蛇咬傷后輕度肢體腫脹的患者，患者癥狀消褪時間、住院時間，對照組與實驗組數據無明顯差異（P>0.05）。中、重度腫脹的患者，實驗組癥狀消褪時間、住院時間均顯著優于對照組，差異有統計學意義（P<0.05）。對照組不良反應的發生率為9.77%，顯著低于實驗組的29.85%，差異有統計學意義（P<0.05）。 結論 毒蛇咬傷后的肢體輕度腫脹首選常規劑量，同樣有效，且副作用較小。中重度肢體腫脹的患者，采用大劑量進行治療，取得顯著臨床效果，可短時間內改善患者不適，值得臨床推廣應用。

[關鍵詞] 毒蛇咬傷；肢體腫脹；地塞米松；劑量

[中圖分類號] R646 [文獻標識碼] B [文章編號] 1673-9701（2018）19-0086-03

Clinical observation of different hormones dosage in treating limb swelling after poisoning snake bite

LI Zhen WANG Haihua ZHANG Zengyu GAO Feng

Department of Emergency， the First People's Hospital of Xiaoshan District in Hangzhou City， Hangzhou 311200， China

[Abstract] Objective To study the effect of different doses of hormones on swollen limbs after poisonous snake bites. Methods From May 2014 to September 2017， 267 cases of poisonous snake bites were collected from emergency department of our hospital. The patients were routinely detoxified by incising wound and received systemic intravenous injection of antivenin. According to the degree of swelling of the injured limb， 267 patients were randomly divided into mild， moderate and severe groups. Patients with the same degree of swelling were randomly divided into control group and experimental group and then injected different dosages of dexamethasone. The control group received conventional dose of 10 mg dexamethasone， the experimental group received high dose of 20 mg. Symptom fade time and hospitalization time were compared between the two groups. Results There was no significant difference in symptom fade time， hospitalization time between the control group and the experimental group（P>0.05） in patients with mild limb swelling after poisonous snake bite. In patients with moderate and severe limb swelling， the symptom fade time， hospitalization time of experimental group were significantly shorter than the control group， the difference was statistically significant（P<0.05）， the incidence of adverse reactions in the control group was 9.77%， which was significantly lower than that of the experimental group of 29.85%， the difference was statistically significant（P<0.05）. Conclusion Slight swelling of limbs after poisonous snake bites is recommended conventional dose， which is equally effective， with less side effects. In patients with moderate to severe limb swelling， the use of high doses of hormones can achieve significant clinical results and improve patient discomfort in a short time， it is worth of clinical application.

[Key words] Snake bite； Limb swelling； Dexamethasone； Dose

毒蛇咬傷在我國南方地區十分常見，相關數據統計顯示，蛇咬傷的發病率約為0.03%，死亡率為5%～10%[1]，致殘喪失勞動力占25%～30%[2]。特別是每年5～10月份，大量的毒蛇咬傷病例集中出現在急診。筆者研究收集的蛇傷病例范圍位于杭州市蕭山區，該區行政區域面積超過1400平方公里，但是唯有我院一家醫院存備抗蛇毒血清制劑，周邊鄉鎮的百姓毒蛇咬傷之后，輾轉多家醫院，數小時甚至十余小時后才能到達我院就診。血清的延后性投藥與肢體腫脹程度直接相關，輕則影響勞動力，重則導致骨筋膜室綜合征、橫紋肌溶解、組織壞死致殘[3-4]。本文結合2014年5月～2017年9月期間收錄的267例毒蛇咬傷后肢體腫脹病例進行治療分析，現報道如下。