蝰蛇蛇伤致肾损害临床分析

目的 研究圆斑蝰泰国亚种蛇伤伴发肾损伤的临床特点.方法 回顾性分析2006年6月～2013年12月住院的蝰蛇蛇伤患者的临床资料.根据病情予抗蛇毒血清、利尿、透析、中西医结合等多种治疗.观察患者蛇伤以及肾损害转归情况.结果 蝰蛇蛇伤76例,发现尿蛋白阳性75例（98.7％）,血清肌酐增高46例（60.5％）,最高为1192 μmol/L,急性肾功能衰竭10例（13.2％）.蛇伤临床治愈61例（80.3％）,显效13例（17.1％）,死亡2例（2.6％）,死亡原因为合并多脏器功能衰竭,直接死亡原因是呼吸循环衰竭,总有效率为97.4％.肾损害经治疗61例（80.3％）2周内恢复,13例（17.1％）半年内恢复.结论 蝰蛇蛇伤肾损伤多见,临床上应常规进行尿检、血肌酐等检查以利于早期诊断.及时采取中西医结合方法治疗蛇伤所致的肾损害疗效确切.

Clinical analysis of renal damage induced by Viper snakebite

Objective To study the clinical features of snakebite of Vipera russellii Thailand subspecies complicated by renal damage. Methods Clinical information of the patients with Viper snakebite hospitalized from June 2006 to December 2013 was analyzed retrospectively.Multiple treatment including antivenin,diuresis,dialysis and the treatment of integrated traditional Chinese and western medicine was given based on the state of illness.The snakebite and outcomes of renal damage were observed. Results Among 76 patients with snakebite,positive urine protein was observed in 75 patients （98.7%）,serum creatinine increasing was observed in 46 patients （60.5%）, with the maximum of 1192 μmol/L,and acute renal function failure was observed in 10 patients （13.2%）.Regarding to snakebite,6l patients （80.3%） were clinically cured,13 patients （17.1%） were remarkably effective and 2 patients （2.6%） died.The cause of death was the complication of multiple organ failure and the direct cause of death was respiratory circulation failure,the total effective rate was 97.4%.Regarding to renal damage,61 patients （80.3%） recovered within 2 weeks of treatment and 13 patients （17.1%） recovered within 6 months of treatment. Conclusion Renal damage induced by Viper snakebite is commonly seen,clinical examinations including routine urinalysis and serum creatinine examination should be conducted for the purpose of early diagnosis.Timely adoption of integrative medicine shows accurate efficacy in the treatment of renal damage induced by snakebite.