毒蛇咬伤的综合救治

目的　总结提高毒蛇咬伤抢救成功率的综合救治经验。方法　 1993年 1月～ 2 0 0 2年12月共收治 5 4 7例毒蛇咬伤患者 ,以应用精制抗蛇毒血清为主的综合治疗 ;治疗中注意肺、脑、肾、血液、循环功能的监护 ,早期发现、处理脏器受损 ;使用大剂量肾上腺皮质激素和山莨菪碱对抢救蛇伤患者提高临床疗效。结果　治愈 5 0 1例 (91 6 % ) ;好转 2 8例 (5 1% ) ;功能障碍 8例 (1 5 % ) ,其中植皮2例 ,截肢 2例 ,截指 (趾 ) 3例 ,肢体偏瘫 1例 ;死亡 10例 (1 8% )。结论　毒蛇咬伤致多器官衰竭是致死的高危因素 ,运用综合对症治疗可降低毒蛇咬伤的死亡率。

Comprehensive treatment for patients bitten by venomous snakes

Objectives To summarize experiences and improve efficacy of comprehensive treatment for patients with wound bitten by venomous snakes. Methods Totally, 547 patients with wound bitten by venomous snakes were hospitalized during January 1993 to December 2002, with comprehensive treatment focusing on purified antivenom serum and paying attention to intensive care for the lung, brain, kidney, blood and circulatory function to detect and handle with viscera damage earlier. Large-dose corticosteroid and anisodaminie was used in treatment for snake-bitten patients to improve clinical effects.Results Among 547 patients, 501 were cured (91.6%), 28 (5.1%) improved, and limb dysfunction was left in 8 (1.5%), including two needed skin grafting, fingers or toes amputed in three and one hemiplegia, and ten died with a case-fatality ratio of 1.8%. Conclusions Multiple organ failure caused by venomous snake bite is one of high risk factor leading to death. Comprehensive and symptomatic treatment for snake-bitten wound can reduce its case-fatality.