标题：负压封闭引流技术联合季德胜蛇药片治疗对毒蛇咬伤患者创面愈合和肢体肿胀的影响

      作者：陈尚扣 1，刘建敏 2，石善秋 1    1.汉中市中心医院急诊医学科，陕西 汉中 723000；2.陕西省人民医院急诊外科，陕西 西安 710068

      卷次： 2023年34卷17期

      【摘要】 目的 探究负压封闭引流技术(VSD)联合季德胜蛇药片治疗对毒蛇咬伤患者创面愈合和肢体肿胀的影响。方法 回顾性分析2017年1月至2021年12月于汉中市中心医院接受治疗的104例毒蛇咬伤患者的临床资料，将其中51例接受VSD治疗者纳入对照组，53例接受VSD联合季德胜蛇药片治疗者纳入观察组。比较两组患者治疗7 d后的临床疗效，以及治疗前和治疗2 d、7 d后创面大小、凝血功能[凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)]、血清肌红蛋白(Mb)、血清肌酸激酶(CK)水平、肢体周径和全身炎症反应[白细胞计数(WBC)、中性粒细胞(N)、C反应蛋白(CRP)、降钙素(PCT)]水平。结果 治疗 7 d后，观察组患者的总有效率为96.08%，明显高于对照组的82.35%，创口愈合率为(88.10±7.16)%，明显高于对照组的(84.26±7.43)%，差异均有统计学意义(P<0.05)；观察组患者的创面愈合时间为(2.53±1.12) d，明显短于对照组的(3.28±1.35) d，差异有统计学意义(P<0.05)；治疗后，观察组患者的PT、APTT、TT分别为(13.31±2.48) s、(30.48±3.94) s、(21.76±2.38) s，明显短于对照组的(15.21±3.34) s、(33.47±4.26) s、(25.46±2.96) s，差异均有统计学意义(P<0.05)；治疗后，观察组患者的血清Mb、CK分别为(154.93±16.14) μg/L、(219.53±22.31) U/L，明显低于对照组的(183.76±18.47) μg/L、(248.97±25.63) U/L，肢体周径为(14.32±1.65) mm，明显小于对照组的(17.19±1.79) mm ，差异均具有统计学意义(P<0.05)；治疗后，观察组患者的WBC、N、CRP分别为(5.98±1.24)个/视野、(8.63±1.37)个/视野、(11.48±1.65) mg/L，明显低于对照组的(7.36±1.43)个/视野、(10.19±1.55)个/视野、(14.33±1.84) mg/L，差异均具有统计学意义(P<0.05)。结论 VSD联合季德胜蛇药片治疗能够促进毒蛇咬伤患者创面愈合，改善患者凝血功能，减轻肢体肿胀，缓解全身炎症反应。
      【关键词】 负压封闭引流技术；季德胜蛇药片；毒蛇咬伤；创面愈合；肢体肿胀
      【中图分类号】 R646 【文献标识码】 A 【文章编号】 1003—6350（2023）17—2475—05

Effects of vacuum sealing drainage combined with Jidesheng Sheyao Tablets on wound healing and limb swellingin patients with venomous snake bite.
CHEN Shang-kou 1, LIU Jian-min 2, SHI Shan-qiu 1. 1. Department of EmergencyMedicine, Hanzhong Central Hospital, Hanzhong 723000, Shaanxi, CHINA; 2. Department of Emergency Surgery, ShaanxiProvincial People’s Hospital, Xi'an 710068, Shaanxi, CHINA
【Abstract】 Objective To explore the effects of vacuum sealing drainage (VSD) combined with JideshengSheyao Tablets on wound healing and limb swelling in patients with venomous snake bite. Methods The clinical da-ta of 104 patients with venomous snake bite who received treatment in Hanzhong Central Hospital from January 2017to December 2021 were retrospectively analyzed. Among the patients, 51 who received VSD were included in controlgroup, and 53 who were treated with VSD combined with Jidesheng Sheyao Tablets were enrolled as observationgroup. The clinical efficacy after 7 days of treatment, and wound size, coagulation function [prothrombin time (PT),activated partial prothrombin time (APTT), thrombin time (TT)], serum myoglobin (Mb), serum creatine kinase (CK),limb circumference, and systemic inflammatory response [white blood cell count (WBC), neutrophil (N), C-reactiveprotein (CRP), procalcitonin (PCT)] before treatment and after 2 days and 7 days of treatment were compared betweenthe two groups. Results After 7 days of treatment, the total effective rate was 96.08% in the observation group, sig-nificantly higher than 82.35% in the control group (P<0.05); and the wound healing rate was (88.10±7.16)%, signifi-cantly higher than (84.26±7.43)% in the control group (P<0.05). The wound healing time was (2.53±1.12) d in the ob-servation group, significantly shorter than (3.28±1.35) d in the control group (P<0.05). The PT, APTT, and TT were(13.31±2.48) s, (30.48±3.94) s, and (21.76±2.38) s in the observation group, significantly shorter than (15.21±3.34) s,(33.47±4.26) s, and (25.46±2.96) s in the control group (P<0.05). Serum Mb, CK, and limb circumference were (154.93±16.14) μg/L, (219.53±22.31) U/L, and (14.32±1.65) mm in the observation group, which were significantly lower/smaller than (183.76±18.47) μg/L, (248.97±25.63) U/L, and (17.19±1.79) mm in the control group (P<0.05). TheWBC, N, and CRP were (5.98±1.24)/field, (8.63±1.37)/field, and (11.48±1.65) mg/L in observation group, which weresignificantly lower than (7.36±1.43)/field, (10.19±1.55)/field, and (14.33±1.84) mg/L in the control group (all P<0.05).Conclusion VSD combined with Jidesheng Sheyao Tablets can promote the wound healing, improve the coagulationfunction, alleviate the limb swelling, and relieve the systemic inflammatory response.
      【Key words】 Vacuum sealing drainage; Jidesheng Sheyao Tablets; Venomous snake bite; Wound healing; Limbswelling