抗蛇毒血清治疗毒蛇咬伤206例

毒蛇咬伤是山区农村医院夏秋季常见外科急诊之一,病情急,并发症多,一般均需住院治疗,且存在一定的死亡率。我院自１９８３年开始应用抗蛇毒血清为主综合治疗毒蛇咬伤,取得满意疗效,报道如下。１临床资料１．１一般资料抗蛇毒血清治疗组:２０６例,男１４２例,女６４例,中位年龄３５．５岁(７～７１岁),其中确认为蝮蛇蛟伤者１５４例,五步蛇咬伤３１例,竹叶青蛇咬伤９例,蛇种不清者１２例(根据蛇蛟地点、典型临床表现,绝大多数仍可确定为蝮蛇咬伤);咬伤至就诊时间平均２８ｈ(０．５～９６ｈ）;按“毒蛇蛟伤病情分型标准”［２］:轻型１４０例,…     

蛋白组学技术在抗蛇毒血清研究中的运用

毒蛇咬伤是热带、亚热带地区比较常见,给公众健康带来严重危害的一类疾病。动物源性的抗蛇毒血清是现代蛇伤治疗的主要手段,但是由于蛇毒成分复杂,且存在种内、种间变异,由全蛇毒免疫所获得的抗蛇毒血清存在诸多不足之处。随着蛋白组学技术在蛇毒研究的应用,使人们对蛇毒的研究有了一些新的认识,近年来出现的"蛇毒蛋白组学"(Venomics)和"抗蛇毒血清组学"(Antivenomics)技术的出现,为生产新型的、毒素特异性的抗蛇毒血清带来了可能,本文现就"蛇毒蛋白组学"(Venomics)和"抗蛇毒血清组学"(Antivenomics)在蛇毒研究及抗蛇毒血清设计和质量控制等几个方面进行综述。     

清热解毒凉血汤联合抗蛇毒血清治疗蝮蛇咬伤的应用研究

目的：研究清热解毒凉血汤联合抗蛇毒血清治疗蝮蛇咬伤的应用效果。方法选取2013年1月～2014年6月确诊并收治的蝮蛇咬伤患者90例,将所有患者按照2∶1随机分组法分为治疗组60例和对照组30例,对照组应用抗蛇毒血清治疗,治疗组在对照组基础上应用清热解毒凉血汤治疗,比照两组疗效及症状消失时间。结果两组患者均成功救治,总有效率100%。治疗组其症状消失时间显著短于对照组,差异有统计学意义（P＜0.05）。结论清热解毒凉血汤联合抗蛇毒血清治疗蝮蛇咬伤疗效确切。     

抗蛇毒血清联合季德胜蛇药治疗蝮蛇咬伤致肢体肿胀的临床观察

目的：探讨抗蛇毒血清联合季德胜蛇药治疗蝮蛇咬伤致肢体肿胀的临床效果。方法本次医学研究选择2009年1月-2012年12月本院收治的100例蝮蛇咬伤患者为研究对象,将其随机分为对照组和试验组,对照组仅接受抗蛇毒血清治疗,试验组接受抗蛇毒血清联合季德胜蛇药片治疗,比较两组患者临床疗效和脏器功能。结果试验组患者临床治疗总有效率和脏器功能评分改善情况均优于对照组,差异有统计学意义（ P ＜0.05）。结论抗蛇毒血清联合季德胜蛇药片治疗蝮蛇咬伤具有较为满意的临床疗效。     

注射用抗蛇毒血清分段稀释滴注对蛇咬伤患者的解毒疗效分析与临床护理

目的:分析注射用抗蛇毒血清分段稀释滴注对蛇咬伤患者的解毒疗效及其临床护理。方法:选取2014年1月—2015年10月期间收治的蛇咬伤患者76例,按给药方法不同将其分为对照组和研究组,每组38例;对照组患者均给予传统脱敏注射法注射抗蛇毒血清治疗,研究组患者均给予分段稀释滴注法注射抗蛇毒血清治疗,比较两组患者治疗后过敏反应的发生率以及患者对护理的满意度和住院时间。结果:研究组患者给药后过敏反应的发生率明显低于对照组(P<0.05);患者对护理的满意度明显高于对照组(P<0.05);患者住院时间明显短于对照组(P<0.05)。结论:采用抗蛇毒血清分段稀释滴注法对蛇咬伤患者解毒治疗,可避免假阳性和假阴性的判断结果,发挥过敏试验、治疗和脱敏的三重作用,简化治疗和护理过程,减少过敏反应的发生。     

中西医结合治疗毒蛇咬伤572例效果分析

目的 ：探讨中西医结合治疗毒蛇咬伤的临床疗效。方法 ：2003年1月-2013年6月松江区车墩镇社区卫生服务中心收治的蛇咬伤572例,采用抗蛇毒血清,季德胜蛇药片或＂1号蛇伤散＂内服治疗,分析中西医结合治疗的疗效。结果 ：治愈546例,好转17例,转院9例,治愈率为95.5%。结论 ：中西医结合治疗毒蛇咬伤疗效好,时间短,可在农村社区进行推广。     

不同病因急性弥漫性血管内凝血临床特点及指标观察

目的探讨感染、急性白血病、病理产科3种不同病因急性弥漫性血管内凝血(DIC)临床特点及血小板(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fg)、凝血酶时间(TT)、硫酸鱼精蛋白副凝(3P)试验、D-二聚体(D-D)阳性率在不同病因DIC中有无差异。方法回顾性分析青岛市第八人民医院2006年11月至2010年11月收治住院的71例以感染、急性白血病、病理产科为基础病的DIC患者的临床资料,对比3种不同病因DIC患者临床出血程度、休克、重要器官损害、微血管溶血表现及PLT、PT、APTT、Fg、TT、3P试验、D-二聚体阳性率。结果 3组患者在出血程度、休克发生率、重要器官损害发生率、疗效、病死率、APTT阳性率方面比较,差异有统计学意义(P<0.05),在PLT、PT、Fg、TT、3P试验、D-二聚体阳性率方面,3组比较差异无统计学意义(P>0.05)。组间两两比较结果显示,感染组与急性白血病组、病理产科组在出血程度、重要器官损害发生率、疗效、病死率方面比较有统计学意义(P<0.05);急性白血病组与感染组、病理产科组在休克发生率方面比较有统计学意义(P<0.01);急性白血病组和感染组在APTT阳性率方面比较,差异有统计学意义(P<0.01)。结论病理产科相关DIC和急性白血病相关DIC临床出血重,器官损害较少,预后较好。感染相关DIC出现休克、器官损害多见,疗效、预后差、病死率高。     

复方三角草片抗蛇毒作用的实验研究

目的:研究复方三角草片抗蛇毒损伤的药理作用.方法:将SD大鼠随机分为蛇毒损伤组,复方三角草片低、高剂量组以及季德胜蛇药片组,各组动物均给药3 d,1次/d,末次给药后1 h以五步蛇蛇毒液皮下注射,另设一正常对照组.观察各组动物中毒表现,计算动物死亡率和药物对蛇毒损伤动物的保护率,取血作凝血分析.结果:与蛇毒损伤组相比,各药物治疗组动物的局部和全身中毒症状均较轻,死亡率较低;但纤维蛋白原(FIB)、血浆凝血酶原时间(PT)、凝血酶时间(TT)无明显变化(P＞0.05).结论:复方三角草片及季德胜蛇药片均对五步蛇毒中毒大鼠有保护作用.     

注射用白眉蛇毒血凝酶对外科手术切口的止血效果

目的:观察白眉蛇毒血凝酶对外科手术切口的止血效果。方法:采用随机单盲法,入选220例外科手术患者,随机分为治疗组60例,阳性对照组60例,空白对照组60例和自身对照组40例。治疗组60例患者分别于术前90min肌注及术前30min静注1KU的白眉蛇毒血凝酶,观察其对手术切口单位面积出血量和出血时间的影响,以单位面积出血量的减少率作为评价临床疗效的指标。阳性对照组和空白对照组分别用蛇凝血酶注射剂(立止血)和生理氯化钠溶液,自身对照组观察40例患者用和不用白眉蛇毒血凝酶自身对照。结果:治疗组和阳性对照组的单位面积出血量的减少率分别为53%和56%,差异无显著性(P>0.05)。自身对照组给药前、后的单位面积出血量和出血时间分别为(0.34±0.15)g·cm~(-2),(133.6±55.8)s及(0.23±0.11)g·cm~(-2),(96.0±38.0)s,单位面积出血量的减少率为32%。治疗组及自身对照组共100例患者的显效率为49%,有效率为41%,总有效率为90%。结论:注射用白眉蛇毒血凝酶能减少手术切口的单位面积出血量,缩短出血时间。     

蛇毒血凝酶与蒙脱石散联合鼻饲治疗新生儿应激性溃疡出血疗效观察

目的探讨蛇毒血凝酶与蒙脱石散联合鼻饲治疗新生儿应激性溃疡出血的疗效。方法将我院2007年5月至2011年4月收治107例应激性溃疡出血新生儿随机分成治疗组58例和对照组49例。2组基础治疗相同,治疗组在此基础上加用蛇毒血凝酶与蒙脱石散联合鼻饲治疗,每日3次。治疗后观察临床疗效、出血停止时间,同时观察不良反应。结果治疗组总有效率为94.8%,止血时间为(1.01±0.487)d;对照组总有效率为79.6%,止血时间为(1.55±0.649)d。两组比较差异均有统计学意义(χ2=5.7765,P<0.05;t=4.924,P<0.05),且无不良反应发生。结论蛇毒血凝酶与蒙脱石散联用治疗新生儿应激性溃疡出血效果显著。     

Hemostatic disturbances observed in patients with snakebite in south China.

To investigate the hematological disorders after snakebite, we measured the maximum platelet aggregation rate (MAR), antithrombin III (AT-III) activity, alpha(2)-plasmin inhibitor (alpha(2)-PI) activity, concentration of fibrinogen (Fg) and fibrin degradation products (FDP) in 25 samples from 17 patients with snakebite in south China. The results obtained in the patients before application of antivenom and patients with Ophiophagus hannah (Oh.) bite were as follows: (1) the mean MAR values were significantly decreased in the case of the snakebites from Vipera russellii (Vr.) and Trimeresurus mucrosquamatus (Tm.); (2) the mean activities of AT-III were decreased in all patients in the present study; 3) the mean activities of alpha(2)-PI were significantly decreased in patients bitten by Deinagkistrodon acutus (Da.), Agkistrodon halys (Ah.), Vr., Trimeresurus stejnegeri (Ts.), Tm. and Naja naja atra (Nn.); (4) the mean concentrations of Fg were markedly decreased in patients bitten by Da., Ah., Vr., Ts. and Tm.; and (5) the mean levels of FDP were significantly increased in cases of Da., Vr. and Ts. bite, but not in Ah., Tm., Nn. and Oh. bite. The results of the present study indicate that disorders of platelet aggregation and the coagulation-fibrinolysis system are liable to occur in patients with snakebite from Da., Ah., Vr., Ts., Tm. and Nn. Furthermore, it appeared that disseminated intravascular coagulation (DIC) was evoked in some patients. Specific antivenom was found to be useful for improving the hemostatic disturbances after snakebite from Ah. and Nn.     

多发伤患者出现DIC的早期诊断和治疗

目的观察52例多发伤患者弥散性血管内凝血的早期诊断及早期给予血小板、冷沉淀、凝血酶原复合物、血浆、肝素治疗的临床效果。方法对多发伤患者早期进行血小板计数、凝血功能、D-二聚体检查,对合并DIC的52例患者根据其血小板计数、凝血功能给予血小板、冷沉淀、凝血酶原复合物、血浆、肝素治疗并观察治疗后1天患者的血小板计数、凝血功能。结果治愈46例,死亡6例,治愈率88．5％。52例患者输注血小板、冷沉淀、凝血酶原复合物、血浆、肝素治疗后1天与输注前相比,患者的血小板计数明显增加,凝血酶原时间（PT）明显缩短,纤维蛋白原（Fbg）含量增加。结论对多发伤并发DIC患者早期输注血小板、冷沉淀、凝血酶原复合物、血浆、肝素等综合治疗可有效阻止DIC的继续发展,重建凝血机制,恢复机体功能。     

血必净注射液改善急性肝衰竭患者凝血功能临床分析

目的：探究血必净注射液对各种病因致急性肝衰竭患者改善凝血功能的作用。方法选取我院2013年6月—2015年4月收治的128例各种病因致急性肝衰竭患者,随机分为对照组和研究组。对照组64例,采用常规综合治疗;研究组64例,在常规综合治疗基础上加用血必净注射液。治疗7 d后,检测两组治疗前后的凝血酶原时间( prothrombin time, PT)、部分凝血酶原时间(partial prothrombin time, APTT)、纤维蛋白原(fibrinogen, FIB)、凝血酶原活动度(prothrombin activi-ty, PTA)、D-二聚体(D dimer, D-D)、血小板(platelet, PLT)计数,以及进行终末期肝病模型(the model for end-stage liver dis-ease, MELD)评分。同时把两组各20例弥漫性血管内凝血(disseminated intravascular coagulation, DIC)患者治疗后血凝指标进行比较(其中研究组20例为A组,对照组20例为B组)。结果研究组MELD评分明显低于对照组(P<0．01);凝血功能指标变化：治疗后对照组和研究组PT、APTT、FIB、PTA、D-D、PLT计数均较治疗前得到改善(P<0．01),其中研究组中各指标均显著优于对照组(P<0．01)。治疗后A组和B组血凝指标优于治疗前,A组血凝指标亦显著优于B组(P<0．01)。结论急性肝衰竭患者常规治疗联合应用血必净注射液,能够有效改善凝血功能,延缓DIC 的进程。     

Endotoxin-induced disseminated intravascular coagulation in vitamin E deficient rats

The effect of vitamin E on endotoxin-induced experimental disseminated intravascular coagulation (DIC) was studied in rats deficient in and supplemented with vitamin E. Experimental DIC was induced by a 4-hr sustained infusion of endotoxin at a dose of 13.3 mg/kg. After the infusion, fibrinogen and fibrin degradation products were increased, platelet count and fibrinogen level were decreased, and prothrombin time and partial thromboplastin time were prolonged. In addition, the number of renal glomeruli with fibrin thrombi was increased. These changes were significantly greater in vitamin E deficient rats when compared to those changes found in rats supplemented with vitamin E. These results indicate that vitamin E plays a protective role in endotoxin-induced DIC.     

Hematological studies on DIC-like findings observed in patients with snakebite in south China.

To clarify the characteristics of the hematological disturbances evoked by snakebite, we measured the antithrombin III (AT-III) activity, alpha2-plasmin inhibitor (alpha2-PI) activity, fibrinogen concentration (Fg) and level of fibrin degradation products (FDP) in 21 patients envenomed by several snakes in south China between August 1998 and October 1999. The hematological changes observed were as follows: the mean activities of AT-III were decreased in patients bitten by Ophiophagus hannah (Oh.), Bungarus fasciatus (Bf.), Hydrophis cyanocinctus (Hc.), Rhabdophis subminiatus (Rs.), and Trimeresurus stejnegeri (Ts.), while those of alpha2-PI were decreased in all patients in the present study; Fg was not detectable in the case of Rs. bite, and the Fg concentration after Ts., Oh., Hc. and Bf. bites also decreased markedly thereby increasing the mean levels of FDP in all patients. It thus appeared that DIC-like syndrome was caused in patients envenomed by snakebite. In the present study, we found that patients who were bitten by Rs., which is still being classified as a non-venomous snake, exhibited complete defibrinogenation and severe hemorrhage without any evidence of severe multiple organ damage. We also found that patients with Ts. bite showed marked hemostatic disturbance without severe multiple organ damage. It is considered that such a discrepancy between the hematological findings and clinical symptoms could be a characteristic phenomenon of the DIC-like syndrome induced by snakebite, especially by Rs. and Ts. bites.     

Improving effect of the synthetic protease inhibitor E-3123 on experimental DIC in dogs]

Disseminated intravascular coagulation (DIC) is a severe syndrome associated with generalized, intractable bleeding and multiple organ failure. Synthesized protease inhibitors such as gabexate mesilate and nafamostat mesilate show an improving effect on DIC, which develops by a chain reaction involving the coagulation, fibrinolysis, complement and kallikrein systems. Experimental DIC was developed in Beagle dogs by infusion of 150 U/kg tissue thromboplastin (Group I), and the improving effect of a new synthetic protease inhibitor, E-3123, was examined. The following groups of animals were treated with drugs: Group II (n = 4) was given with 5 mg/kg/hr of E-3123; group III (n = 4) was given 10 mg/kg/hr of E-3123; and group IV was given 6 mg/kg/hr of gabexate mesilate (GM). Although improvement of the hemodynamics or peripheral circulation was not apparent, a slight, but insignificant, improvement of lactate/pyruvate was noted in the treated groups. On the other hand, the hemostatic abnormalities such as prolongation of prothrombin time and activated thromboplastin time; decreases of platelet count, fibrinogen and alpha 2-antiplasmin; and increases of fibrin degradation products were significantly improved in the treated groups. These results indicate that E-3123 is effective for improving experimental DIC, and it is suggested that E-3123 is applicable for the treatment of clinical DIC.     

Effect of intraperitoneal injection of topical thrombin on the coagulation and fibrinolysis of rabbits with experimental liver damages

Topically applied thrombin was known to be effective in hemostasis of local bleeding, but complications of shock, anaphylaxis or disseminated intravascular coagulation (DIC) have been reported recently in rare cases. In this experiment, the possibility of DIC was examined by intraperitoneal injection of topical thrombin (Parke-Davis) to rabbits with liver cirrhosis or acute liver damages induced by CCl4. No significant changes in the coagulation parameters were found in the groups of liver cirrhosis or the untreated control, but the injection of thrombin induced decreases of platelet count and fibrinogen and prolongation of prothrombin time and partial thromboplastin time in the groups of acute liver damages, 24 or 48 hr after CCl4 injection. When the "junk" prepared from the topical thrombin was injected to the 48 hr-damage group, no change was noted in these parameters. It was concluded that DIC could be induced by the intraperitoneal injection of topical thrombin only in cases of acute liver damages, where the increased permeability of peritoneum was postulated. However, such an immediate or marked change in coagulation was not found in our experiment as encountered in the clinical cases, which suggested the involvement of the anaphylactic reaction to the topical application of thrombin in the development of DIC in these clinical cases.     

The effects of higenamine on LPS-induced experimental disseminated intravascular coagulation (DIC) in rats

The effect of higenamine, a benzyl-tetrahydroisoquinoline alkaloid of the roots of Aconitum spp. (Ranunculaceae), on disseminated intravascular coagulation (DIC), was investigated using an experimental DIC rat model. The oral administration of higenamine (10 mg/kg or 50 mg/kg), significantly ameliorated the decrease of fibrinogen level in plasma, the increase of fibrinogen/fibrin degradation product (FDP) level, and the prolongation of prothrombin time (PT) induced by the i. v. infusion of lipopolysaccharide (LPS). The prolongation of activated partial thrombin time (aPTT) and the decrease of platelet count were suppressed. The increase in serum aspartate aminotransferase (AST) and blood urea nitrogen (BUN) were also significantly prevented with higenamine. The above results are suggestive that higenamine has therapeutic potential for DIC and/or accompanying multiple organ failure (MOF).     

Antagonism by salvianolic acid B of lipopolysaccharide‐induced disseminated intravascular coagulation in rabbits

The aim of the present study was to investigate the effects of salvianolic acid B on lipopolysaccharide (LPS)‐induced disseminated intravascular coagulation (DIC) in rabbits. Continuous infusion of LPS was used to induce a DIC model in rabbits. Treatment with salvianolic acid B (1, 3 or 6 mg/kg) was started simultaneously with LPS infusion (0.5 mg/kg LPS in 60 mL saline; 10 mL/h over a period of 6 h) through the contralateral marginal ear vein. Activated partial thromboplastin time (APTT), prothrombin time (PT), platelet count and fibrinogen concentration were determined, as were plasma levels of fibrin–fibrinogen degradation products (FDP), alanine aminotransferase (ALT), blood urea nitrogen (BUN), protein C activity, antithrombin III (ATIII) and tumour necrosis factor (TNF)‐α concentration. The gradual impairment of haemostatic parameters was induced by continuous infusion of LPS. There were marked increases in APTT, PT, BUN, ALT and plasma TNF‐α and marked decreases in the platelet count, fibrinogen, FDP, protein C and ATIII. The intravenous administration of 1, 3 or 6 mg/kg salvianolic acid B attenuated the increases in APTT, PT, BUN, ALT and plasma TNF‐α and the decreases in fibrinogen, platelet, FDP, protein C and ATIII induced by LPS infusion. These observations indicate that salvianolic acid B has an effect against LPS‐induced DIC in rabbits.