Comparison of the effect of simple small incision decompression and VSD negative pressure closure and drainage on venomous snake bite
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摘要: 目的 探讨单纯小切口切开减压与负压封闭引流(vacuum sealing drainage，VSD)对毒蛇咬伤部位及肢体肿胀治疗效果比较，为临床并发症的治疗提供有效且可行的治疗方案。方法 选取334例毒蛇咬伤肢体肿胀的患者，按入院顺序分为治疗组196例和对照组138例。两组患者均早期给予标准化综合治疗，对照组应用传统单纯小切口切开减压治疗，治疗组采用VSD治疗，对两组患者的治疗效果进行比较分析。结果 患者住院时间由对照组(4.72±2.00) d缩短至治疗组(2.25±1.17) d，患者的医疗费用由对照组(4 962.18±918.92)元减少致至治疗组(2 845.77±580.48)元，差异均有统计学意义(均P < 0.01)，患者的治愈率由对照组的83.33%提高到治疗组的94.90%。结论 VSD对毒蛇咬伤肢体肿胀、坏死的疗效优于单纯小切口切开减压引流治疗。Abstract: Objective To investigate the effect of simple small incision incision decompression and vacuum sealing drainage(VSD) negative pressure closure and drainage on the treatment of venomous snake bite site and limb swelling, so as to provide an effective and feasible treatment plan for the treatment of clinical complications.Methods A total of 334 patients with venomous snake bite limb swelling were randomly divided into treatment group and control group, with 196 cases in the treatment group and 138 cases in the control group. The patients in both groups were treated with standardized comprehensive treatment at an early stage, the control group was treated with traditional simple small incision and decompression, and the treatment group was treated with VSD negative pressure closure and drainage, and the treatment effects of the two groups were compared and analyzed.Results The length of hospital stay was shortened from the control group(4.72±2.00) days to the treatment group(2.25±1.17) days, and the medical expenses of the patients decreased from the control group(4 962.18±918.92) yuan to the treatment group(2 845.77±580.48) yuan, the difference was statistically significant(all P < 0.01), and the cure rate of patients increased from 83.33% in the control group to 94.90% in the treatment group.Conclusion The efficacy of VSD negative pressure closure drainage on the swelling and necrosis of venomous snake bite limb is better than that of simple small incision incision and decompression drainage.
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Key words:
- snake bites /
- viper /
- drainage /
- effect evaluation
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表 1 两组患者一般资料比较
X±S 项目 对照组(138例) 治疗组(196例) 统计量 P 年龄/岁 45.38±14.88 47.90±16.91 t=-1.409 0.160 性别/例(%) χ2=0.215 0.643 男 86(62.32) 127(64.80) 女 52(37.68) 69(35.20) 婚姻状况/例(%) χ2=0.434 0.805 已婚 94(68.12) 127(64.80) 未婚 26(18.84) 42(21.43) 不详 18(13.04) 27(13.77) 文化程度/例(%) χ2=0.581 0.901 初中以下 17(12.32) 24(12.24) 初中 53(38.41) 68(34.70) 高中 46(33.33) 72(36.73) 大学及以上 22(15.94) 32(16.33) 医保类型/例(%) χ2=3.087 0.378 职工医保 19(13.77) 17(8.68) 新农合医保 72(52.17) 118(60.20) 城镇医保 36(26.09) 47(23.98) 自费 11(7.97) 14(7.14) 毒蛇种类/例(%) χ2=3.605 0.608 尖吻蝮 26(18.84) 28(14.29) 蝮蛇 66(47.83) 107(54.59) 烙铁头 32(23.19) 48(24.49) 蝰蛇 6(4.35) 7(3.57) 眼镜蛇 5(3.62) 3(1.53) 竹叶青 3(2.17) 3(1.53) 蛇伤程度/例(%) χ2=3.597 0.071 中度 73(52.90) 124(63.27) 重度 65(47.10) 72(36.73) SSS评分/分 8.22±2.46 8.34±2.25 t=-0.479 0.632 实验室检查 白细胞计数/(×109/L) 10.62±2.29 10.21±2.80 t=1.433 0.153 C反应蛋白/(mg/L) 7.83±2.85 8.29±2.94 t=-1.427 0.155 肌酸激酶/(U/L) 575.56±245.92 614.97±267.90 t=-1.369 0.172 肌酸激酶同工酶/(U/L) 58.75±46.87 66.78±55.89 t=-1.379 0.169 肌红蛋白/(ng/mL) 121.34±46.74 115.01±37.74 t=1.366 0.173 Cr/(μmoI/L) 155.08±66.16 144.53±56.49 t=1.565 0.118 活化部分凝血活酶时间/s 38.64±12.15 36.98±10.05 t=1.365 0.173 凝血酶原时间/s 14.76±5.13 15.24±6.47 t=-0.716 0.474 纤维蛋白原/(g/L) 2.23±1.29 2.14±1.02 t=0.690 0.291 凝血酶时间/s 23.61±5.96 22.674±5.74 t=1.443 0.150 血小板/(×109/L) 159.24±51.72 168.83±62.17 t=-1.486 0.138 
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表 2 两组患者治疗效果比较
X±S 项目 对照组(138) 治疗组(196) 统计量 P 抗蛇毒血清追加剂量/支 0(0，2) 0(0，1) Z=2.014 0.044 骨筋膜室综合征/例(%) 7(5.07) 3(1.53) Fisher精确概率 0.036 皮肤肿胀切排减压/例(%) 42(30.43) 31(15.82) χ2=10.133 0.001 住院时间/d 4.72±2.00 2.25±1.17 t=14.185 < 0.001 预后效果/例(%) χ2=12.286 0.002 伤残 6(4.35) 2(1.02) 好转 17(12.32) 8(4.08) 痊愈 115(83.33) 186(94.90) 医疗费用/元 4 962.18±918.92 2 845.77±580.48 t=25.766 < 0.001
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