Evaluation of the clinical efficacy of Ji Desheng snake tablets combined with aminophenol tramadol in patients by pit viper bites in Xuzhou and its surrounding areas
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摘要: 目的 观察徐州及周边地区蝮蛇咬伤患者中季德胜蛇药片联合氨酚曲马多的临床效果。方法 回顾性分析2019年5月至2023年9月在徐州市中心医院急诊病房住院的244例蝮蛇咬伤患者的病例资料，根据治疗方法分为季德胜蛇药片联合氨酚曲马多组(A组，114例)与单用季德胜蛇药片组(B组，130例)。主要观察2组住院时间和疼痛消退时间，同时观察2组治疗前、治疗第1天及第3天的疼痛评分、白细胞介素6(IL-6)、超敏C-反应蛋白(hs-CRP)、白细胞计数(WBC)、中性粒细胞百分比变化，以及不良反应和补救镇痛发生率。结果 244例患者分属徐州市80例(32.8%)，宿州市84例(34.4%)，淮北市42例(17.2%)，宿迁市38例(15.6%)。A组和B组间性别、年龄、体重指数、基础疾病、咬伤部位、咬伤严重评分、治疗前的疼痛评分、治疗前hs-CRP、治疗前IL-6、治疗前WBC、治疗前中性粒细胞百分比比较，差异均无统计学意义。A组疼痛消退时间、住院时间较B组明显缩短，差异有统计学意义(P＜0.05)。治疗第1天，A组疼痛评分、IL-6水平较B组明显下降，差异有统计学意义(P＜0.05)；治疗第3天，A组和B组的疼痛评分、IL-6水平较治疗前均明显下降，但2组间差异无统计学意义。治疗第1天，A组hs-CRP、WBC、中性粒细胞百分比较B组明显下降，差异有统计学意义(P＜0.05)；治疗第3天，A组和B组间hs-CRP、WBC、中性粒细胞百分比差异无统计学意义。2组均未见不良反应，A组补救镇痛2例(1.8%)，B组补救镇痛14例(10.8%)，2组比较差异有统计学意义(P＜0.05)。结论 中成药季德胜蛇药片联合西药氨酚曲马多方案能够显著减轻蝮蛇咬伤患者的疼痛程度，缩短住院时间，有利于患者快速康复，值得在临床进一步推广应用。Abstract: Objective To observe the clinical effect of Ji Desheng snake tablets combined with aminophenol tramadol in patients by pit viper bites in Xuzhou and its surrounding areas.Methods The clinical data of 244 pit viper bite patients hospitalized in the emergency ward of Xuzhou Central Hospital from May 2019 to September 2023 were retrospectively analyzed. Patients were divided into the group of Ji Desheng snake tablet combined with aminophenol tramadol(Group A, 114 cases) and the group of Ji Desheng snake tablet alone(Group B, 130 cases). The main observation was the comparison of hospitalization time and pain subsidence time between the two groups. At the same time, the pain scores, interleukin-6(IL-6), high-sensitivity C-reactive protein(hs-CRP), white blood cell count(WBC), percentage change in neutrophil count before treatment, on the first day of treatment, and on the third day of treatment, as well as the occurrence rates of adverse events and the need for remedial analgesia in both groups were observed.Results The 244 patients belonged to 80 cases(32.8%) in Xuzhou City, 84 cases(34.4%) in Suzhou City, 42 cases(17.2%) in Huaibei City, and 38 cases(15.6%) in Suqian City. There were no significant differences in gender, age, body mass index, underlying disease, bite site, bite severity score, pre-treatment pain score, pre-treatment hs-CRP, pre-treatment IL-6, pre-treatment WBC, and pre-treatment neutrophil percentage between the two groups. Pain subsidence time and hospitalization time were significantly shorter in group A compared with group B, and the difference was statistically significant(P < 0.05). On the first day of treatment, the pain score and IL-6 of group A significantly decreased compared with group B, and the difference was statistically significant(P < 0.05). On the third day of treatment, the pain scores and IL-6 of both group A and group B significantly decreased compared with the pre-treatment period, and there was no significant difference between the two groups. Compared with group B, the level of hs-CRP, WBC, neutrophil percentage expression significantly decreased in group A on the first day of treatment, and the difference was statistically significant(P < 0.05). On the third day of treatment, there was no significant difference in the level of hs-CRP, WBC, and neutrophil percentage expression between group A and group B. No adverse events were occurred in both groups. There was 2 case(1.8%) of remedial analgesia in group A and 14 cases(10.8%) of remedial analgesia in group B, and the difference was statistically significant(P < 0.05).Conclusion The regimen of Chinese patent medicine Ji Desheng snake tablets combined with western medicine aminophenol tramadol can significantly alleviate the pain and shorten the hospital stay of patients with pit viper bites. This is beneficial for the rapid recovery of patients and is worthy of further clinical promotion and application.
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Key words:
- pit viper bites /
- epidemiology /
- Ji Desheng snake tablets /
- aminophenol tramadol /
- clinical effect
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表 1 2组患者基线资料比较
指标 A组(114例) B组(130例) 男∶女/例 64∶50 76∶54 年龄/岁 57.8±13.2 53.2±12.3 体重指数/(kg/m2) 26.1±2.5 25.9±2.4 基础疾病/例(%) 高血压 18(15.8) 20(15.4) 糖尿病 16(14.0) 14(10.8) 冠心病 4(3.5) 8(6.2) 咬伤部位/例(%) 上肢 46(40.4) 56(43.1) 下肢 68(59.6) 74(56.9) SSS评分△ 1.96 2.01 △咬伤严重评分采用蛇咬伤严重度评分量表(snakebite severity scale，SSS)，轻度0~3分，中度4~7分，重度8~20分。 
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