毒蛇咬伤的中西医结合用药分析

目的探讨毒蛇咬伤的临床中西医结合用药状况。方法随机抽取本院近年毒蛇咬伤病例１２０份进行统计与分析。结果在毒蛇咬伤的临床用药中,以清热解毒、利水消肿、益气养血的中药与抗蛇毒、抗炎、抗过敏、抗休克、利尿排毒和保护脏器功能的西药结合用率达１００％。结论中西医结合治疗蛇伤,有利于内外同治,标本兼治,提高临床治愈率。     

中西医结合治疗五步蛇咬伤中毒性心肌炎

在毒蛇咬伤中,多种毒蛇咬伤中毒后可导致心脏等多脏器功能衰竭。其中,五步蛇咬伤后还可引起心肌损害,出现中毒性心肌炎,重者可导致心力衰竭,心律失常,甚至危及生命[1]。为了探讨治疗本病的有效方法,我们采用中西医结合治疗五步蛇咬伤所致中毒性心肌炎30例取得较好的疗效,现报告     

毒蛇咬伤致局部组织肿胀坏死的中西医结合治疗进展

毒蛇咬伤是临床常见的危重病,治疗不及时或治疗不当可能导致患者肢体严重肿胀、坏死甚至死亡。本文综述了毒蛇咬伤所致局部肢体肿胀坏死的发病机制和治疗方法,分析了中西医治疗毒蛇咬伤的优势和存在问题,在毒蛇咬伤的临床治疗中选择中西医结合治疗可互补长短,中西医结合治疗毒蛇咬伤的规范化仍有待进一步提高。     

重、危型毒蛇咬伤在EICU的观察与护理

重、危型毒蛇咬伤病情发展迅速 ,患者中毒症状严重 ,易并发呼衰、急性肾功能不全、DIC等多脏器衰竭 ,病死率极高 ,治疗和护理都有较大的困难。我科近三年来收治 1 2 0多例毒蛇咬伤的病人中有 1 4例重、危型 ,采用综合救治和护理方案 ,并注意早期各脏器功能支持治疗 ,治愈 1 1例 ( 3例因延迟送治时间而死亡 )。现将护理体会报告如下。1　临床资料1.1　一般资料　 1 4例毒蛇咬伤重、危型病人中 ,男 1 1例 ,女 3例 ,年龄 1 0～ 45岁 ,平均年龄 32岁。参照 1 990年第四届蛇伤学术会议制定的“毒蛇咬伤的临床病情分型”全部符合危重型毒蛇咬伤…     

中医药治疗毒蛇咬伤研究进展

本文对中医药治疗毒蛇咬伤的历史渊源,以及目前中医药对毒蛇咬伤辨证分型,局部治疗和全身治疗的方法,中药单药、复方治疗毒蛇咬伤现代药理的研究等方面的研究进展进行了回顾。对中医药治疗毒蛇咬伤的治疗优势和存在问题进行了思考。认为中医药配合抗蛇毒血清等西医基础治疗,在毒蛇咬伤治疗中具有优势。强调了在新医疗环境下中西医的协同配合、互补长短的重要性。指出了中医药在治疗毒蛇咬伤中规范化问题、中药药理研究,以及对重危型患者的救治等方面需要进一步深入研究。     

中西医结合治疗毒蛇咬伤197例报告

目的总结中西医结合治疗毒蛇咬伤的临床疗效。方法对2012年1月~2013年12月我院收治的197例毒蛇咬伤患者给予伤口局部清创处理,应用相应抗蛇毒血清,抗炎、利尿、消肿、抗溶血及中医治疗。结果 197例毒蛇咬伤患者均治愈出院,治愈率100%。结论中西医结合治疗毒蛇咬伤疗效确切,值得临床推广。     

近2年南昌市及周边地区毒蛇咬伤流行病学调查

目的分析南昌市及周边地区毒蛇咬伤的发病情况,为本地区毒蛇咬伤的预防和治疗提供理论依据。方法回顾性分析近2年来我院中医外科收治的毒蛇咬伤患者的临床资料,并对资料完整的1425例进行分析总结。结果南昌市及周边地区毒蛇咬伤具有特有的流行病学特点。毒蛇咬伤多发生在市郊南昌县、新建县等地,时间多集中在夏秋,以早晨和傍晚为高发时段,患者以男性居多,以下肢咬伤多见,致伤蛇种以蝮蛇多见,经及时治疗病情多痊愈。结论南昌及周边地区因其适宜的气候和地理环境,毒蛇咬伤高发,且具有明显区域性、季节性等特征。积极普及防治毒蛇咬伤知识,可降低毒蛇咬伤发病率和伤残、致死率。     

粤西茂名地区毒蛇咬伤的流行病学特征研究

目的探讨茂名地区毒蛇咬伤的流行病学特征。方法收集2014~2019年我院收治的毒蛇咬伤患者1625例的临床资料,对毒蛇种类、性别、年龄、咬伤部位、咬伤地点、伤后就诊时间、住院时间进行统计分析。结果茂名地区主要致伤毒蛇为竹叶青蛇和眼镜蛇;受伤患者以41~70岁男性多见;被咬伤部位主要为腕关节、踝关节以下;咬伤地点多发生在农田及山林处;被蛇咬伤后81.85%的患者在伤后2~8 h就诊,91.32%的患者在治疗1~3天出院。结论茂名地区毒蛇咬伤的主要致伤蛇种为竹叶青和眼镜蛇,野外作业、游玩和田间劳作人员要提高警惕,慎防毒蛇咬伤,一旦被毒蛇咬伤应及时治疗,以减少蛇伤并发症,提高治疗效果。     

毒蛇咬伤的早期救治及其误区(附85例分析)

毒蛇咬伤时有发生,且具有发病急、变化快、并发症多、治疗复杂、致残率高甚至导致死亡等特点．毒蛇咬伤处理不及时或处理方法不当,往往造成不良后果,轻者致残,重者丧失生命。通过回顾分析我院1998年1月～2006年9月收治的85例毒蛇咬伤患者,认为目前毒蛇咬伤的救治关键是早期正确处理。同时发现基层医院还存在一些治疗误区,值得注意。现就治疗问题进行分析。     

毒蛇咬伤致急性呼吸衰竭38例救治分析

目的探讨毒蛇咬伤致急性呼吸衰竭的发病机制和治疗措施。方法选择毒蛇咬伤患者38例,应用抗蛇毒血清、机械通气等综合治疗。结果经综合救治措施治疗,38例全部痊愈出院。结论综合救治措施是抢救毒蛇咬伤致急性呼吸衰竭最有效的方法。     

Detection of venom by enzyme linked immunosorbent assay (ELISA) in patients bitten by snakes in Thailand.

The ability of an enzyme linked immunosorbent assay (ELISA) to detect venom was evaluated in 251 patients bitten by four of the commonest poisonous snakes in Thailand. Serum was tested only from patients who brought the snakes that had bitten them. About one third of all bitten patients had detectable venom antigenaemia, though a smaller proportion were symptomatic. Serum venom concentrations on admission correlated with the severity of clinical manifestations. The test was sensitive and specific even for specimens that had been collected and stored under suboptimal conditions. The technique is suitable for forensic use in cases of suspected snakebite. The combination of snake identification and venom antigen detection should be a more reliable means of studying the epidemiology of snakebite than the measurement of venom antibodies in a population.     

基于动物学、临床医学跨界研究快速准确诊断1例不明蛇类咬伤的分析

目的探讨动物学、临床医学跨界研究成果联合运用于快速准确诊断不明蛇类咬伤中的作用及效果。方法通过回顾性分析1例不明蛇类咬伤患者的临床资料,从病史、动物学生活习性、咬痕鉴别、流行病学、临床表现、蛇类动物学分布6个方面进行剖析不明蛇类咬伤的诊断思路与方法。结果该例蛇伤患者的病史特征以及诊断与鉴别诊断:(1)病史特征符合银环蛇生活习性;(2)咬痕特征首先符合毒蛇咬痕,其次与银环蛇咬痕特征高度吻合;(3)蛇伤流行病学研究支持被咬地域存在银环蛇致伤病种;(4)临床表现首先符合毒蛇咬伤,其次与银环蛇/金环蛇咬伤临床表现高度吻合;(5)依据桂中毒蛇种类分布研究成果结合银环蛇咬痕特征确诊为银环蛇咬伤。结论将蛇类动物学、临床医学跨界研究成果联合运用于不明蛇类咬伤的快速准确诊断是一种切实有效的方法。     

后毒牙类毒蛇

长期以来,人们仅把具有沟牙和管牙的蛇视为毒蛇,然而,近年来发现游蛇科中的虎斑颈槽蛇、红脖颈槽蛇、颈棱蛇、赤链蛇等既无管牙,也无沟牙,却频频发生这类蛇咬伤人后引起中毒的事例,甚至出现被咬伤致严重出血休克死亡的事件。经深入研究后发现,这些蛇虽没有沟牙和管牙,但却具有产生毒性分泌物的毒腺—杜氏腺(Duvernoy′s gland)及皮下腺,且不同的毒腺具有不同的毒性作用,可表现为出血不止、溶血、呼吸困难、肾损害等。这类蛇与毒腺的导管有联系的上颌牙明显粗大,上颌牙与上颌骨、横骨连接牢固,毒腺里的毒液可顺着粗大的上颌牙流入伤口,因此,应视为"后毒牙类毒蛇"。     

Declining snake population—why and how: a case study in the Mangrove Swamps of Sundarban, India

Species diversity of reptiles is much higher in Sundarban than in other mangrove ecosystems in India. Presently snakes are declining in Sundarban due to habitat loss caused by tremendous population pressure. Besides, irresponsible killing to avoid snakebite both from poisonous and nonpoisonous varieties is another reason for the gradual declining snake population. According to an intensive household survey in 35 villages in Sundarban, about 22 species (five poisonous and 17 non-poisonous) of snakes have been identified and there appears to have been a general decline in densities. On the contrary, a large number of people are bitten and die from snakebite every year with 0.57 and 0.34 vulnerability and mortality rate per 10,000 people, respectively. The two most commonly observed poisonous species are the common krait, Bungarus caeruleus (51 %) and common cobra, Naja naja (40 %), and that of non-poisonous varieties are the Ptyas mucosus (41 %), Typhlina bramina (34 %), Xenochrophis piscator (12 %), and Amphiesma stolata (10 %). Apart from killing of snakes out of fear; habitat loss, unscientific handling of snakes by snake catchers and charmers, and netting by fisherman contributes to snake mortality to a large extent; 72 % killed snakes are of poisonous varieties, 60 % of which are B. caeruleus, the most venomous snake in Sundarban. This paper is an attempt to highlight some of the important conservation efforts like the introduction of snake firms, alternative employment channels for the snake charmers and catchers, and mass awareness campaign through panchayet (village level governing body) and local NGOs.     

中西医结合治疗毒蛇咬伤773例

目的：探讨中西医结合治疗各类型毒蛇咬伤的临床方法。方法根据１９６４－１９９８年收治各类型毒蛇咬伤患者７７３例的临床资料,分析中草药、西医综合对症治疗及灵活应用抗蛇毒血清的临床疗效。结果治愈７６５例,治愈率９９．０％;死亡８例,死亡率。结果治愈７６５例,治愈率９９．０％;死亡８例,死亡率１．０％。结论建立完善的抢救治疗队伍,采用中西医结合的综合性治疗方法,可明显提高临床治愈率。     

Odorous and Non-Fatal Skin Secretion of Adult Wrinkled Frog (Rana rugosa) Is Effective in Avoiding Predation by Snakes

The roles played by nonfatal secretions of adult anurans in the avoidance of predation remain unknown. The adult Wrinkled frog (Rana rugosa) has warty skin with the odorous mucus secretion that is not fatal to the snake Elaphe quadrivirgata. We fed R. rugosa or Fejervarya limnocharis, which resembles R. rugosa in appearance and has mucus secretion, to snakes and compared the snakes’ responses to the frogs. Compared to F. limnocharis, R. rugosa was less frequently bitten or swallowed by snakes. The snakes that bit R. rugosa spat out the frogs and showed mouth opening (gaping) behavior, while the snakes that bit F. limnocharis did not show gaping behavior. We also compared the responses of the snakes to R. rugosa and F. limnocharis secretions. We coated palatable R. japonica with secretions from R. rugosa or F. limnocharis. The frogs coated by R. rugosa secretion were less frequently bitten or swallowed than those coated by F. limnocharis secretion. We concluded that compared to different frog species of similar sizes, the adult R. rugosa was less frequently preyed upon by, and that its skin secretion was effective in avoiding predation by snakes.     

中药蛇伤熏洗剂治疗蛇伤肢体肿胀的临床研究

目的观察中药蛇伤熏洗剂对蛇伤肢体肿胀患者的疗效。方法选择60例毒蛇咬伤肢体肿胀患者,随机分为治疗组和对照组各30例,对照组给予常规的蛇伤治疗方案,治疗组在对照组治疗的基础上,于咬伤后72h开始使用中药蛇伤熏洗剂熏蒸及肢体浸泡,并观察两组患者咬伤后3天及6天的肢体肿胀程度、5-羟色胺的变化及肿胀消退时间、疗程等指标变化。结果两组患者治疗3天后各项指标比较无统计学意义（P〉0.05）,与治疗前比较均有统计学意义（P〈0.05）;治疗6天后比较,治疗组各项指标改善明显优于对照组,均具有显著统计学意义（P〈0.05）。结论中药蛇伤熏洗剂对蛇伤肢体肿胀的疗效显著,可以明显缩短肿胀消退时间、降低5-羟色胺水平。     

Parental defence on the reef: antipredator tactics of coral‐reef fishes against egg‐eating seasnakes

On coral reefs in New Caledonia, the eggs of demersal‐spawning fishes are consumed by turtle‐headed seasnakes (Emydocephalus annulatus). Fish repel nest‐raiding snakes by a series of tactics. We recorded 232 cases (involving 22 fish species) of antipredator behaviour towards snakes on a reef near Noumea. Blennies and gobies focused their attacks on snakes entering their nests, whereas damselfish (Pomacentridae) attacked passing snakes, as well as nest‐raiders (reflecting territorial defence). Biting the snake was the most common form of attack, although damselfish and blennies also slapped snakes with the tail, or (blennies only) plugged the nest entrance with the parent fish's body. Gobies rarely defended the nest, although they sometimes bit or threw sand at the snake. A snake was more likely to flee if it was attacked before it began feeding rather than after it found the eggs (82% versus 3% repelled) and if bitten on the head rather than the body (68% versus 53%). Tail‐slaps were not effective, although plugging the burrow and throwing sand often caused snakes to flee. These strong patterns reflect phylogenetic variation in fish behaviour (e.g. damselfish detect a snake approach sooner than do substrate‐dwelling blennies and gobies) coupled with intraspecific variation in snake diets. © 2014 The Linnean Society of London, Biological Journal of the Linnean Society, 2015, 114 , 415–425.     

竹叶青蛇咬伤中毒机制及临床研究新进展

竹叶青的毒素成分主要为血液毒素。被竹叶青蛇咬伤后的主要临床表现为出凝血功能障碍,其中最突出的表现是纤维蛋白原(Fib)严重消耗。根据2018年中国蛇伤救治专家共识,在治疗竹叶青蛇咬伤时,主要治疗措施有抗蛇毒血清的应用以及消肿止痛、预防破伤风、使用糖皮质激素等,并根据患者纤维蛋白原情况使用血制品如“新鲜冰冻血浆”及“冷沉淀”等补充人体内凝血物质以改善凝血功能。本文就国内外竹叶青蛇咬伤的中毒机制及临床研究相关文献进行复习并作一综述,为临床诊疗提供参考。