夏瑜 俞利霞 袁丞达 张彩云 刘冰

[摘要] 目的 探讨蛇伤散外敷联合艾灸治疗五步蛇咬伤的临床效果。 方法 选取本院2018年3月～2019年9月门诊患者117例，随机分为观察组59例和对照组58例。对照组給予抗五步蛇毒血清、抗破伤风、糖皮质激素、对症处理、局部处理等西医常规治疗，并给予护理配合;观察组在常规西医治疗与护理配合基础上，咬伤局部给予蛇伤散外敷，并施以八风、八邪灸疗。治疗结束后，进行疗效评价，并观察其他指标，包括消肿时间、止痛时间、臂围差值及住院时间。 结果 观察组、对照组治愈率分别为76.3%、56.9%，两组总体疗效经秩和检验，差异有统计学意义（P<0.05）。观察组、对照组止痛时间分别为（6.3±1.4） h、（11.8±2.9） h，与对照组比较，观察组明显缩短（P<0.05）;观察组、对照组消肿时间分别为（97.3±5.8）h、（152.5±37.2） h，与对照组比较，观察组明显缩短（P<0.05）;观察组治疗前后臂围差值为（5.9±1.1）cm，对照组为（2.5±0.6）cm，与对照组比较，观察组臂围明显减小（P<0.05）;观察组、对照组住院时间分别为（3.9±0.9）d、（5.5±1.2）d，与对照组比较，观察组时间明显缩短（P<0.05）。 结论 蛇伤散外敷联合艾灸治疗五步蛇咬伤在临床疗效、消肿止痛等方面均有效，值得进一步推广应用。

[关键词] 五步蛇咬伤;蛇伤散;艾灸;八风;八邪

[中图分类号] R269          [文献标识码] B          [文章编号] 1673-9701（2020）18-0168-04

Clinical observation and nursing of Sheshang Powder external application combined with moxibustion in treating agkistrodon acutus bite

XIA Yu1   YU Lixia1   YUAN Chengda1   ZHANG Caiyun1   LIU Bing2

1.Dermatology Department， Hangzhou Hospital of Traditional Chinese Medicine， Hangzhou   310007， China; 2.Zhejiang Institute of Traditional Chinese Medicine， Hangzhou   310007， China

[Abstract] Objective To investigate the clinical efficacy of Sheshang Powder external application combined with moxibustion in treating agkistrodon acutus bite. Methods One hundred and seventeen outpatients from March 2018 to September 2019 in our hospital were selected and randomly divided into two groups： the observation group（n=59） and the control group（n=58）. For the control group， routine western medicine treatments such as anti-agkistrodon acutus venom serum， anti-tetanus， glucocorticoid， symptomatic treatment and topical application were given， and nursing cooperation was conducted. For the observation group， on the basis of routine western medicine treatment and nursing cooperation， snakebite was treated with topical application of Sheshangsan and moxibustion of Bafeng & Baxie factors. After the treatment， the curative efficacy was evaluated and other indexes were observed， including detumescence time， analgesic time， arm circumference difference and hospitalization time. Results The cure rates of the observation group and the control group were 76.3% and 56.9%， respectively. The overall curative efficacies of the two groups were tested by rank sum， and the difference was statistically significant（P<0.05）. The analgesic time of observation group and control group was（6.3±1.4） h and （11.8±2.9） h respectively， which was significantly shorter than that of control group （P<0.05）; detumescence time of observation group and control group was（97.3±5.8） h and（152.5±37.2） h respectively， which was significantly shorter than that of control group（P<0.05）. The baseline and post-treatment differences of arm circumference were（5.9±1.1） cm in the observation group and（2.5±0.6） cm in the control group， which was significantly reduced compared with the control group（P<0.05）. The hospital stays of the observation group and the control group were（3.9±0.9） d and（5.5±1.2） d respectively， which was significantly shortened compared with the control group（P<0.05）. Conclusion The observation group is better than the control group in clinical efficacy， detumescence and analgesia in treating agkistrodon acutus bite， which is worthy of further clinical promotion and application.

[Key words] Agkistrodon acutus bite; Sheshang powder; Moxibustion; Bafeng; Baxie

五步蛇学名尖吻蝮蛇，亦称蕲蛇，主要栖息于我国东南、西南、华南地区，是一种我国特有的血循毒剧毒蛇，个体较大，具有毒腺大、毒性强特点，被其咬伤后会出现红肿、胀痛，如不及时治疗，常合并心、肾功能不全等并发症或后遗症，还有截肢、死亡的风险。临床上一经确诊，应立即给予足量抗五步蛇毒血清及对症处理，并积极预防各种并发症、后遗症。中西医结合治疗五步蛇咬伤，往往能收到更好的临床疗效[1-2]。蛇伤散外敷联合八风、八邪艾灸治疗五步蛇咬伤为本院多年经验治法，效果肯定。为进一步探讨其临床疗效，本研究选取117例五步蛇咬伤患者，随机分为对照组、观察组，对照组予西医常规治疗并护理配合，观察组在此基础上联合蛇伤散及艾灸治疗，疗效确切、满意，现报道如下。……