中西医结合规范化治疗蝮蛇咬伤的临床研究
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摘要
目的探讨规范化的中西医结合治疗方案在蝮蛇咬伤中的应用及疗效评价并探讨其作用机制。方法300例患者随机分为对照组和试验组。对照组接受抗蝮蛇毒血清、地塞米松、破伤风免疫球蛋白、抗菌药物、保肝降酶、营养心肌、维持水/电平衡等西医常规治疗方法。试验组在对照组治疗方法基础上再给予八风八邪穿刺、七叶一枝花酊外用、中药熏洗、内服季德胜蛇药片或蛇伤解毒汤等中医治疗方法,分别于治疗前及治疗后,记录患者肢体肿胀疼痛症状积分及消失时间、局部症状积分、全身症状积分;对合并肝肾功能及心肌损害的重症患者,检测治疗前后血清谷丙转氨酶(ALT)、谷草转氨酶(GOT)、尿素氮(BUN)、肌酐(Cr)、肌酸激酶(CK);计算两组治疗愈显率,记录最终痊愈时间,并进行统计学比较。结果两组治疗前患者肢体肿胀、疼痛积分比较,差异无统计学意义(均P> 0.05)。两组治疗后患者肢体肿胀、疼痛积分均较治疗前明显下降,且治疗组治疗后患者肢体肿胀、疼痛积分下降程度均优于对照组(均P <0.05)。治疗后试验组患肢肿胀、疼痛消失时间短于对照组(P <0.05)。两组治疗前患者局部及全身症状的积分比较,差异无统计学意义(均P> 0.05)。两组治疗后患者局部及全身症状的积分均较治疗前明显下降,且治疗组治疗后患者局部及全身症状的积分下降程度均优于对照组(均P <0.05)。两组治疗前患者ALT、GOT、CK、BUN、Cr水平比较,差异无统计学意义(均P> 0.05)。两组治疗后ALT、GOT、CK、BUN、Cr水平均较治疗前明显下降,且治疗组治疗后ALT、GOT、CK、BUN、Cr水平下降程度均优于对照组(均P <0.05)。试验组愈显率97.22%高于对照组的79.58%(P <0.05)。试验组痊愈时间短于对照组(P <0.05)。结论中西医结合规范化方案在蝮蛇咬伤治疗中效果显著。
Objective: To explore the application and efficacy evaluation of standardized integrated traditional Chinese and Western medicine treatment in viper bite. Methods: 300 patients were randomly divided into the treatment group and the control group,150 cases in each. The control group was given conventional treatment methods,such as Agkistrodon hyalys Antivenin,antibiotics,tetanus immunoglobulin,liver protection and enzyme descending,myocardiac nutrition and the balance of water and electricity. On the basis,the treatment group was given combined traditional Chinese medicine,such as eight wind and eight pathogenic piercing,external spray of tincture with paris polyphylla,herbal fumigation,oral Ji Desheng Snake Tablet or snake wound detoxification soup,etc. The scores and symptoms of swelling and pain in the two groups before and after treatment were recorded;levels of serum ALT,GOT,BUN,Cr,CK,curative effects and final cure time in patients with liver and kidney function and myocardial damage were also analyzed;statistical analysis and comparison were carried out. Results:In terms of the scores of swelling and pain of affected limbs,local and systemic symptoms,both groups had curative effects(P < 0.05),and the treatment group was better than the control group(P < 0.05). In terms of markedly effective rate,the treatment group was 97.22%,the control group 79.58%;the treatment group was better than the control group(P < 0.05). The treatment group was also significantly shorter than the control group in the recovery time(P < 0.05). Conclusion: The standardized combination of Chinese and Western medicine has a good clinical effect on Agkistrodon bites,worthy of wide application in primary clinical practice.
Objective: To explore the application and efficacy evaluation of standardized integrated traditional Chinese and Western medicine treatment in viper bite. Methods: 300 patients were randomly divided into the treatment group and the control group,150 cases in each. The control group was given conventional treatment methods,such as Agkistrodon hyalys Antivenin,antibiotics,tetanus immunoglobulin,liver protection and enzyme descending,myocardiac nutrition and the balance of water and electricity. On the basis,the treatment group was given combined traditional Chinese medicine,such as eight wind and eight pathogenic piercing,external spray of tincture with paris polyphylla,herbal fumigation,oral Ji Desheng Snake Tablet or snake wound detoxification soup,etc. The scores and symptoms of swelling and pain in the two groups before and after treatment were recorded;levels of serum ALT,GOT,BUN,Cr,CK,curative effects and final cure time in patients with liver and kidney function and myocardial damage were also analyzed;statistical analysis and comparison were carried out. Results:In terms of the scores of swelling and pain of affected limbs,local and systemic symptoms,both groups had curative effects(P < 0.05),and the treatment group was better than the control group(P < 0.05). In terms of markedly effective rate,the treatment group was 97.22%,the control group 79.58%;the treatment group was better than the control group(P < 0.05). The treatment group was also significantly shorter than the control group in the recovery time(P < 0.05). Conclusion: The standardized combination of Chinese and Western medicine has a good clinical effect on Agkistrodon bites,worthy of wide application in primary clinical practice.
引文
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[13]陈海东,龚旭初,陶菊,等.蝮蛇解毒汤联合红光治疗蝮蛇咬伤伤肢肿胀临床研究[J].中国中医药信息杂志,2018,25(6):26-29.
[14]方勇,丁晓雯.中西医结合治疗老年人蝮蛇咬伤60例临床观察[J].湖南中医,2015,31(12):71-73.
[15]施胜钰,赵炎,武瑞仙.七叶一枝花酊治疗蝮蛇咬伤致肢体肿胀100例[J].中国中医急症,2011,20(10):1661-1662.
[16]刘举达,于庆生,张琦,等.中西医结合治疗重症蝮蛇咬伤26例[J].安徽中医药大学学报,2014,33(16):13-15.
[2]覃公平.中国毒蛇学[M].南宁:广西科学技术出版社,1995:694-718.
[3]中国中西医结合学会急救医学专业委员会.蛇伤急救学组毒蛇咬伤的临床分型及严重程度评分标准[J].中国中西医结合急救杂志,2002,9(1):18.
[4]吴孟超,吴在德.黄家驷外科学[M].7版.北京:人民卫生出版社,2008:102-104.
[5]吴在德,吴肇汉.外科学[M].6版.北京:人民卫生出版社,2003:209.
[6]倪毓生.蛇伤解毒汤[N].中国中医药报,2011-08-01(4).
[7]喻文球,王万春,刁军成,等.中医药干预综合疗法治疗蝮蛇咬伤300例临床观察[J].中医杂志,2011,52(12):1019-1022.
[8]国家中医药管理局.中医病证诊断疗效标准[M].北京:中国医药科技出版社,2012:148-149.
[9]王万春,钟吉富,喻文球,等.蝮蛇咬伤多器官功能障碍综合征诊断标准及中西医结合临床研究[J].辽宁中医杂志,2010,37(6):1014-1016.
[10]倪毓生,孙爱珠.中西医结合治疗蝮蛇咬伤503例临床分析[J].中西医结合杂志,1990,10(21):660-663.
[11]方勇,丁晓雯.倪毓生主任医师诊治蝮蛇咬伤经验[J].新中医,2012,44(9):137-139.
[12]龚旭初,丁晓雯,陈旭,等.蝮蛇咬伤中西医结合治疗1580例[J].蛇志,2009,21(1):41-45.
[13]陈海东,龚旭初,陶菊,等.蝮蛇解毒汤联合红光治疗蝮蛇咬伤伤肢肿胀临床研究[J].中国中医药信息杂志,2018,25(6):26-29.
[14]方勇,丁晓雯.中西医结合治疗老年人蝮蛇咬伤60例临床观察[J].湖南中医,2015,31(12):71-73.
[15]施胜钰,赵炎,武瑞仙.七叶一枝花酊治疗蝮蛇咬伤致肢体肿胀100例[J].中国中医急症,2011,20(10):1661-1662.
[16]刘举达,于庆生,张琦,等.中西医结合治疗重症蝮蛇咬伤26例[J].安徽中医药大学学报,2014,33(16):13-15.