不同剂量激素治疗毒蛇咬伤后肢体肿胀的临床观察

目的研究不同剂量的激素治疗毒蛇咬伤后肢体肿胀的疗效。方法选择2014年5月~2017年9月期间我院急诊科收录的267例毒蛇咬伤病例,予常规切开伤口排毒、全身静滴抗蛇毒血清治疗,依据伤肢肿胀程度的不同将267例患者分为轻度、中度、重度三组,相同肢肿程度的患者内部随机分成对照组和实验组,采用不同剂量的地塞米松治疗,对照组地塞米松采用常规剂量10 mg,实验组采用较大剂量20 mg,比较两组患者的症状消褪时间、住院时间。结果毒蛇咬伤后轻度肢体肿胀的患者,患者症状消褪时间、住院时间,对照组与实验组数据无明显差异(P0.05)。中、重度肿胀的患者,实验组症状消褪时间、住院时间均显著优于对照组,差异有统计学意义(P0.05)。对照组不良反应的发生率为9.77%,显著低于实验组的29.85%,差异有统计学意义(P0.05)。结论毒蛇咬伤后的肢体轻度肿胀首选常规剂量,同样有效,且副作用较小。中重度肢体肿胀的患者,采用大剂量进行治疗,取得显著临床效果,可短时间内改善患者不适,值得临床推广应用。

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

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.