蛇伤Ⅲ号治疗蝮蛇咬伤致急性肾损害26例临床观察

江浙短尾蝮是以血循毒为主的混合毒类蛇种,蛇毒中的磷脂酶A等可引起血管内溶血,红细胞被破坏后产生大量血红蛋白阻塞肾小管;类组胺的释放和循环障碍,导致有效血容量减少,肾小管收缩,肾小球滤过率降低;蛇毒可直接损伤肾小管上皮细胞;蛇毒中的蛋白酶会导致凝血及纤溶酶溶解异常,甚至诱发DIC。     

眼镜蛇毒磷脂酶A2研究概况

综述了眼镜蛇毒磷脂酶Ａ２的酶活性、生物活性（毒性、引起水肿、溶血作用和免疫化学性质等）、活性部位、抗原决定簇和环状ＤＮＡ基因及它们之间的相互关系和应用。并比较了眼镜蛇毒和其它科属蛇毒、蛇毒、猪牛胰、人滑液、椎盘间液等不同来源的磷脂酶Ａ２的某些特性。     

一点红加盐卤治疗天蛇毒

天蛇毒,又名天蛇头、蛇头疔。系指部疔疮之一,多见于手中指或其他手指,局部焮肿赤痛或剧烈跳痛,严重者肿势蔓延手掌或手背,患处流脓血水,手指活动功能障碍。多因在草间接触蜘蛛毒、蛇毒等引起。西医外科常使用抗生素治疗,手指化脓严重者手术切开排脓。笔者家传一点红加盐卤对治疗天蛇毒有着独特的功效。现报告如下。     

宣上通下法治疗蝮蛇咬伤并肾功能损害的探讨

蝮蛇蛇毒属混合毒类。蝮蛇咬伤后,蛇毒毒素直接作用于肾小管内膜形成血栓,酸中毒使肾小球痉挛。蛇毒引起溶血反应,出现血红蛋白尿,并阻塞肾小球,这些均可引起肾缺血,肾小球滤过率急剧下降导致肾功能损害乃致肾功能衰竭。现代医学多采用利尿剂或其他综合疗法、保守疗法无效时则用血透或腹透。不少病人由于解毒药应用不及时或不得当,往往血透、腹透效果不佳。笔者在临床实践中,根据湿温病理论,认为蝮蛇咬伤导致肾功能损害,主要是由于湿毒阻滞三焦,水液代谢障碍,阳气运行受阻,故采用宣上通下法治疗,收到满意效果。 1 蝮蛇伤三焦辨证原理 …     

蛇毒的抗菌作用

蛇毒的抗菌作用以能抑制细菌生长的蛇毒的最低浓度，进行眼镜蛇、金环蛇、五步蛇、蝮蛇、竹叶青蛇６种蛇毒对４种细菌（金黄色葡萄球菌、大肠杆菌、绿脓杆菌、福氏痢疾杆菌）的抑茵试验。结果，以蝮蛇毒、眼镜蛇毒的抑菌作用比较强，而抗菌谱也较宽。它们的抗菌浓度一般都...     

卜芥抗蛇毒作用的初步药理研究

通过卜芥对蛇毒中毒小白鼠的保护试验,证明其对眼镜蛇毒、眼镜王蛇毒中毒小白鼠的保护作用均非常显著;对银环蛇毒中毒小白鼠亦有保护作用;卜芥的炮制品作用强于其原生药;有效部份为强酸型阴离子交换树脂交换物,卜芥和其有效部份的抗蛇毒作用均与钠离子有关。     

清热解毒、通便利尿法治疗毒蛇咬伤验案举隅

中医学将毒蛇咬伤概括为风毒型(神经毒)、火毒型(血循毒)、风火毒型(混合毒)3种证型.尽管风毒、火毒、风火毒的毒理和病理不同,但其基本病因仍然是蛇毒[1].毒蛇咬伤后,证候复杂,涉及脏腑多,但根本上还是影响了三焦的水液代谢与阳气输布,导致水液代谢失调、阳气输布不畅.故在治疗上,关键要清热解毒、通便利尿,二便一通,蛇毒暑湿方得以排泄.湖南浏阳地区山多林深,夏秋之季,毒蛇咬伤较为常见.笔者自2005年以来,采用该法治疗取得肯定疗效,兹举验案如下.     

广西眼镜蛇毒L-氨基酸氧化酶的分离纯化及体外抗血小板聚集作用

目的 从广西眼镜蛇粗毒中分离纯化L-氨基酸氧化酶(L-amino acid oxidase,LAAO),并对其物理、生化性质及体外抗血小板聚集作用进行研究.方法 用Sephacryls-200凝胶过滤,DEAE-Sepharose CL-6B离子交换,CM-Sepharose CL-6B离子交换层析法分离纯化广西眼镜蛇毒中的LAAO,用SDS-聚丙烯酰胺凝胶电泳在还原与非还原条件下测定其蛋白分子量,等电聚焦法测定等电点,比浊法测定广西眼镜蛇LAAO对二磷酸腺苷、胶原、凝血酶、花生四烯酸引起的血小板聚集率的影响.结果 从广西眼镜蛇毒中分离出的LAAO分子量约为55.2 KD,等电点为7.6;生物活性检测发现,该蛋白不具有磷脂酶A2和精氨酸酯酶活性,无纤溶及出血活性,能明显抑制二磷酸腺苷、胶原、凝血酶、花生四烯酸引起的血小板聚集,并呈明显的正相关.结论 分离纯化的广西眼镜蛇毒LAAO为电泳纯,并具有较强的抑制体外血小板聚集作用.     

眼镜王蛇咬伤的治疗体会

目的 探讨眼镜王蛇咬伤的治疗方法.方法 对确认为眼镜王蛇咬伤的86例患者实施局部封闭,应用抗眼镜蛇毒血清和抗银环蛇毒血清等多种治疗手段治疗.结果 86例患者全部治愈,治疗时间最长6d,最短1d,平均3d.结论 眼镜王蛇咬伤早期采取正确有效的急救措施,清除蛇毒,阻止蛇毒进一步扩散,减轻和缓解中毒反应,是治疗眼镜王蛇咬伤的重要环节.     

小远志醇提物抗蛇毒活性初探

通过比较小远志不同浓度乙醇提取物对眼镜蛇毒及蝮蛇毒中毒小鼠的保护作用来评价它们的抗蛇毒药效，发现95％乙醇提取物具有最佳抗蛇毒药效；继续对95％7,醇提取物的分段萃取部分（石油醚部分、氯仿部分、乙酸乙酯部分、正丁醇部分）进行抗蛇毒活性筛选实验，发现乙酸乙酯萃取部分对中毒小鼠有较明显的保护作用。说明抗蛇毒活性成分可能是一种或多种中小极性物质，为临床应用及有效成分的提取提供了依据，也减少了盲目性。     

悦目金蛛粗毒的提取和制备

目的 了解掌握悦目金蛛生活习性和形态特征,分析毒腺形态与体量的相关性,优化明确制毒路线,获得较纯生理活性较高的蜘蛛粗毒.方法 通过毒腺形态解剖,借助数理统计方法分析了毒腺形态与蜘蛛体量的相关性;采用毒腺解剖法直接获取性质稳定和最多量的蛛毒粗品,以鸡红细胞为模型检验了粗毒效价,探索了毒素离子通道抑制类型.结果 毒腺重量与体量呈正相关,按照优化后的制备方法和技术线路,制得5 mg悦目金蛛粗毒;悦目金蛛毒素有促进红细胞凝集和裂解作用,在钙离子环境下毒素对红细胞的裂解作用更强.结论 利用毒腺解剖法能够获得最大量更高纯度的蛛毒,初步确定了蛛毒当中含有凝集素和磷脂酶两种成分.     

中西医治疗毒蛇咬伤研究进展

中医治疗毒蛇咬伤以清解蛇毒、通利二便为主,使患者体内的蛇毒逐步排出体外。中医外治法主要有中药外敷、中药熏洗、针刺疗法、艾灸疗法、中药灌肠等。西医治疗毒蛇咬伤有局部治疗和全身综合治疗。辨明是何种毒蛇咬伤、了解各个地区的主要致伤蛇种以及掌握其咬伤地点、发病人群等在毒蛇咬伤的诊断及治疗中起到至关重要的作用。毒蛇咬伤可导致全身各个系统受到损害,了解咬伤后人体的实验室指标变化,以便指导用药。毒蛇咬伤如救治不及时,常可导致多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)的发生,而肾脏是最容易发生衰竭的器官,血液净化在救治危重症毒蛇咬伤方面可起到积极作用,能提高治愈率,降低病死率。     

壮药逐毒解筋蛇药散1号方治疗风火毒型蛇伤疗效观察

目的：探讨逐毒解筋蛇药散1号方治疗风火毒型蛇伤的疗效。方法：选择80例确诊为风火毒型蛇伤患者的临床资料进行分析。结果：经逐毒解筋蛇药散1号方治疗,观察组患者的蛇伤肿胀消退时间、疗程时间及并发症发生率明显低于对照组,总有效率为95.0％,明显高于对照组,经比较,P〈O.05,差异具有统计学意义。结论：逐毒解筋蛇药散1号方治疗风火毒型蛇伤的临床疗效确切,可以明显缩短患者的肿胀消退时间和疗程,值得推广应用。     

毒蛇咬伤早期多处减张切开引流的治疗体会

目的： 目的分析早期多处减张切开引流治疗毒蛇咬伤的疗效.方法： 回顾我院2004年-2009年收治的毒蛇咬伤25例患者的临床资料,分析其疗效.结果：本组20例患者经早期多处减张切开引流治疗后,均取得了满意的效果,平均治愈天数11天,无一例死亡.结论： 毒蛇咬伤早期多处减张切开引流可及早排除局部残留的蛇毒,防止毒液继续蔓延,改善全身症状,缩短疗程.     

三角草抗蛇毒作用的实验研究

目的:研究三角草抗蛇毒损伤的药理作用。方法:SD大鼠随机分为蛇毒损伤组;三角草低、高剂量组;季德胜蛇药片组。以上各组动物各给药3d,1次/d。末次给药后1h以五步蛇蛇毒液皮下注射。另设一正常对照组。各组动物进行中毒表现观察、计算动物死亡率和药物对蛇毒损伤动物的保护率以及取血作凝血分析。结果:与蛇毒损伤组相比,除三角草高剂量组外,其余药物治疗组动物的局部和全身症状较轻,死亡率较低(P<0.05);FIB,PT,TT无明显变化(P>0.05)。结论:低剂量三角草及季德胜蛇药片均对五步蛇毒中毒大鼠有保护作用;但三角草的高剂量对蛇毒中毒大鼠无保护作用,相反具有一定的毒副作用。     

Use of Pavo cristatus feather extract for the better management of snakebites: neutralization of inflammatory reactions

In Indian traditional medicine, peacock feather in the form of ash (Bhasma) or water extract are used against snakebite and to treat various problems associated with lungs. This study was aimed to evaluate the water extract of peacock feather (PCF) against the local tissue damage caused due to snakebite. PCF water extract showed inhibition towards phospholipase A2 enzyme activity from snake venom (Naja naja and Vipera russelii), inflammatory fluids (synovial, pleural, ascites) and normal serum in a dose-dependent manner. Hyaluronidase and proteases are other major enzymes in snake venoms responsible for local tissue damage. PCF water extract inhibited hyaluronidase and proteolytic enzyme activities from Vipera russelii, Naja naja and Trimeresurus malabaricus venom. The active principle is a hydrophilic molecule easily extractable in water or polar solvents. PCF water extract gave positive results for the presence of protein and secondary metabolites like carotenoids and steroids. Analysis of metal ions revealed that iron is the major ion (> 20-fold). Other metal ions detected in smaller amount are copper, chromium, zinc and nickel. The least amount of ion detected is gold. Co-injection of PCF water extract with snake venom and inflammatory PLA2 enzymes neutralize the edema inducing activity of all the PLA2 enzymes studied. Since it inhibits hyaluronidase and proteases enzyme activity from snake venom PCF water extract is a powerful neutralizing agent, which has therapeutic application against venom toxicity.     

外伤致肩锁关节盘钙化并游离误诊1例分析

锁骨远端骨折临床中很少见,而外伤致肩锁关节盘钙化、游离,在创伤骨科中更是少见。外伤致肩锁关节盘钙化并游离,在影像学中往往因肩锁关节部特殊的解剖关系而易误诊为肩峰骨折或是锁骨远端骨折,造成误诊、误治,现将我科收治的1倒报告如下。     

Snake venom neutralization by Indian medicinal plants (Vitex negundo and Emblica officinalis) root extracts

The methanolic root extracts of Vitex negundo Linn. and Emblica officinalis Gaertn. were explored for the first time for antisnake venom activity. The plant (V. negundo and E. officinalis) extracts significantly antagonized the Vipera russellii and Naja kaouthia venom induced lethal activity both in in vitro and in vivo studies. V. russellii venom-induced haemorrhage, coagulant, defibrinogenating and inflammatory activity was significantly neutralized by both plant extracts. No precipitating bands were observed between the plant extract and snake venom. The above observations confirmed that the plant extracts possess potent snake venom neutralizing capacity and need further investigation.     

Antihemorrhagic, antinucleolytic and other antiophidian properties of the aqueous extract from Pentaclethra macroloba

Several Brazilian plants have been utilized in folk medicine as active agents against various effects induced by snake venoms. The inhabitants of the Amazon region use, among others, the macerated bark of a plant popularly named "Pracaxi" (Pentaclethra macroloba Willd) to combat these effects. We report now the antihemorrhagic properties against snake venoms of the aqueous extract of Pentaclethra macroloba (EPema). EPema exhibited full inhibition of hemorrhagic and nucleolytic activities induced by several snake venoms. Additionally, partial inhibition of myotoxic, lethal, phospholipase and edema activities of snake venoms and its isolated PLA(2)s by EPema is reported. In vivo tests showed that EPema is able to totally inhibit a Bothrops jararacussu metalloprotease (BjussuMP-I) induced hemorrhage, suggesting interaction of the extract compounds with this high molecular weight protein. The extract did induce neither hemorrhage nor death in mice when administered alone by i.m. route. When administered separately by i.m. route, the extract did not induce death in mice at 12.5--300 mg/kg doses. Other assays demonstrated that EPema was unable to inhibit fibrinogenolytic and coagulant activities of Bothrops atrox venom. Although the mechanism of action of EPema is still unknown, the finding that no visible change was detected in the electrophoretic pattern of snake venom after incubation with the extract excludes proteolytic degradation as a potential mechanism. The search for new inhibitors of venom metalloproteases and DNAases are a relevant task. Investigation of snake venom inhibitors can provide useful tools for the elucidation of the action mechanisms of purified toxins. Furthermore, these inhibitors can be used as molecular models for development of new therapeutical agents in the treatment of ophidian accidents.     

Anticoagulant and antifibrinogenolytic properties of the aqueous extract from Bauhinia forficata against snake venoms

The aqueous extract from aerial parts of Bauhinia forficata was able to neutralize the clotting activity induced by Bothrops and Crotalus crude venoms. The clotting time, upon human plasma, induced by B. moojeni venom was significantly prolonged. Clotting and fibrinogenolytic activities induced by isolated thrombin-like enzyme from Bothrops jararacussu were totally inhibited after incubation at different ratios. The extract was not able to neutralize the hemorrhagic activity induced by an Bothrops venoms, but it efficiently inhibited the edema induced by Crotalus durissus terrificus venom and isolated PLA2s. In addition, it did not inhibited the phospholipase A2 activity of Bothrops snake venoms. Interaction studies between Bauhinia forficata extract and snake venoms, when analyzed by SDS-PAGE, did not reveal any apparent degradation of the venom proteins. This extract is a promising source of natural inhibitors of serine-proteases involved in blood clotting disturbances induced by snake venoms.