张丽　　兰频　　赖林杰　　陈义

[摘要] 目的 探討负压封闭引流（VSD）在毒蛇咬伤中的临床效果。 方法 选择2018年4月至2020年5月在我院诊断治疗的毒蛇咬伤患者60例为研究对象，随机分为观察组与对照组，每组各30例。对照组给予常规治疗，观察组在此基础上加用负压封闭引流。比较治疗后两组血清CK、CRP水平，肿胀程度，住院时间，随访瘢痕大小。 结果 ①观察组治疗3 d、7 d血清CK为（272.2±51.3）U/L、（94.6±22.4）U/L、CRP为（44.8±10.2）mg/L、（12.6±3.0）mg/L水平均显著低于对照组，差异有统计学意义（P<0.05）。②治疗7 d后，观察组肿胀程度显著轻于对照组，差异有统计学意义（P<0.05）。③观察组住院时间为（9.4±2.1）d，显著短于对照组;瘢痕面积为（3.3±0.6）cm2，显著小于对照组，差异均有统计学意义（P<0.05）。 结论 负压封闭引流治疗毒蛇咬伤可有利于毒液的排出，缓解肿胀程度，缩短住院时间，减小瘢痕面积。

[关键词] 负压封闭引流;毒蛇;咬伤;肿胀

[中图分类号] R459.7          [文献标识码] B          [文章编号] 1673-9701（2021）13-0095-04

Clinical application effect of vacuum sealing drainage in poisonous snake bite

ZHANG Li   LAN Pin   LAI Linjie   CHEN Yi

Department of Emergency， Lishui Central Hospital in Zhejiang Province， Lishui   323000， China

[Abstract] Objective To explore the clinical effect of vacuum sealing drainage （VSD） in poisonous snake bite. Methods A total of 60 patients undergoing snakebite who were diagnosed and treated in our hospital from April 2018 to May 2020 were selected as study subjects and randomLy divided into two groups， with 30 cases in the observation group and 30 cases in the control group. The control group was given conventional treatment. The observation group was given vacuum sealing drainage on the basis of the control group. After treatment， the serum CK and CRP levels， the degree of swelling， the length of hospital stay， and the size of scars at follow-up visits were compared between the two groups after treatment. Results ①Serum CK （272.2±51.3）U/L， （4.6±22.4）U/L and CRP （44.8±10.2）g/L， （2.6±3.0）mg/L levels in the observation group 3 days and 7 days after treatment were significantly lower than those in the control group， and the differences were statistically significant（P<0.05）. ②7 days after treatment， the degree of swelling in the observation group was significantly than that in the control group， and the difference was statistically significant（P<0.05）. ③The length of stay in the observation group  was（9.4±2.1） d significantly shorter than that in the control group， and the scar area （3.3±0.6）cm2 was significantly smaller than that in the control group. The differences were statistically significant（P<0.05）. Conclusion Vacuum sealing drainage（VSD） in the treatment of poisonous snake bite can help the discharge of venom， relieve swelling， shorten the length of hospital stay， and reduce the scar area.

[Key words] Vacuum sealing drainage （VSD）; Poisonous snake; Bite; Swelling

毒蛇在我国南方省区常见，毒蛇咬伤在我国南部沿海、山区、农村是常见的创伤，如果处理不当，可导致严重后果，甚至危及生命。储存于毒蛇毒腺的毒液经导管至毒牙，咬伤人体后，经伤口进入人体内，然后经血液循环、淋巴循环进行扩散，导致局部中毒症状及全身中毒症状[1-2]。负压封闭引流（Vacuum sealing drainage，VSD）是一种面状引流的方法，将特殊的材料填塞于创面，临床上可用于肢体严重软组织损伤中[3-4]。本研究将VSD应用于毒蛇咬伤后创面毒液引流，观察其效果，现报道如下。

1 资料与方法

1.1 一般资料

2018年4月至2020年5月，根据纳入标准与排除标准选择60例于我院治疗的毒蛇咬伤患者为研究对象。纳入标准[5]：结合病史、临床表现、辅助检查，确诊为血循毒蛇咬伤[6];咬伤至就诊时间<12 h，入院前未行任何治疗;年龄≥18周岁;对本研究知情同意。排除标准[5]：认知功能障碍，既往有慢性疾病病史，既往有重要脏器功能障碍史。60例患者采用随机的方法分为观察组与对照组，每组各30例。两组患者性别、年龄、受伤至入院时间、入院时血清CK水平比较，差异无统计学意义（P>0.05），具有可比性。

1.2 方法

對照组采用常规治疗，结扎伤口近心端，采用0.1%利多卡因0.1 g（山东华鲁制药有限公司，国药准字H37022147，规格：5 mL/0.1 g）联合地塞米松5 mg（天津金耀集团湖北天药药业股份有限公司，国药准字H42020019，规格：1 mL/5 mg）在创口周围或近侧进行封闭，切开清创排毒，避免过度清创，双氧水冲洗伤口，包扎。……