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目的:研究血浆置换方法在极危重型蝮蛇咬伤(内科常规应用抗蛇毒血清后病情仍继续恶化)患者中的临床意义。方法:1回顾性分析解放军总医院第一附属医院急救部2004-01-2014-01按照急救医学会蛇伤急救学组制订的毒蛇咬伤的严重程度评分标准,确诊为极危重型蝮蛇咬伤即DIC样综合征(得分=3分)且内科常规应用抗蛇毒血清后病情仍继续恶化患者58例。2检测患者伤后24h内临床资料,对比包括行血浆置换治疗前后临床表现、肝肾功能、行血小板检测、普通凝血功能检查及血栓弹力图检测结果;3分析预后情况。结果:1极危重患者PLT下降,FIB明显下降甚至不能测出,D-二聚体明显升高,PT明显延长,甚至出现不凝血状态。2血栓弹力图显示:极危重患者R值与K值均明显增大,MA值与α角度明显减小。3血浆置换前后:凝血功能检测结果对比,PLT、FIB、D-二聚体明显升高,PT均明显改善,差异有统计学意义(P<0.05);肝肾功能检测结果对比,显著低于治疗前水平,差异有统计学意义(P<0.05)。4治愈率为62.1%,显效率为27.5%,有效率为5%,无效率为0。结论:运用传统凝血功能实验及血栓弹力图监测凝血指标能够有效发现极危重蝮蛇咬伤凝血功能障碍;血浆置换可有效治疗及改善病情严重程度,为临床救治提供指导。
Objective: To study the clinical significance of plasmapheresis in patients with critically ill Agkistrodon halystrinae (medical conditions continue to worsen after anti-snake venom serum). Methods: A retrospective analysis of the First Affiliated Hospital of PLA General Hospital Department of Emergency 2004-01-2014-01 According to the emergency medical services snakebolt first aid group developed the severity of poisonous snake bite grading standards, diagnosed as extremely dangerous viper bite 58 cases of injury were DIC-like syndrome (score = 3) and the condition deteriorated after routine use of anti-snake venom in medical department. 2 detected within 24 hours after injury in patients with clinical data, including comparison of the clinical manifestations before and after the plasma exchange therapy, liver and kidney function, platelet test, common coagulation test and thrombus elastography test results; 3 analysis of prognosis. Results: In a critically ill patient, PLT decreased, FIB decreased significantly or even undetectable, D-dimer was significantly increased, PT significantly prolonged, and even non-coagulation status. 2 Thromboelastometry showed: R and K values were significantly increased in severely critically ill patients, MA values and α angle decreased significantly. 3 before and after plasma exchange: coagulation test results compared PLT, FIB, D-dimer was significantly increased, PT were significantly improved, the difference was statistically significant (P <0.05); liver and kidney function test results were significantly lower than Before treatment, the difference was statistically significant (P <0.05). The cure rate was 62.1%, markedly effective rate was 27.5%, effective rate was 5%, and inefficiency rate was 0. CONCLUSION: The coagulation tests using traditional coagulation tests and thrombi elastography can effectively detect coagulation dysfunction in severely viper snake bites. Plasma exchange can effectively treat and improve the severity of the disease, providing guidance for clinical treatment.