蝮蛇咬伤10885例救治分析

目的：探讨提高蝮蛇咬伤的救治水平。方法,回性总结我院１９７２－１９９９年蝮蛇咬伤患者１０８８５年,采用抗蝮蛇毒血清结合中药蛇伤合剂治疗;对合并急性呼吸衰竭的８５例患者,早期气管切开保持气管畅通,同时正压人工呼吸;对合并急性肾功能衰竭的１０３例患者,早期碱化尿液,应用足量利尿剂,必须时进行腹膜透析;对合并急性心功能衰竭的４３例患者,在应用强心、利尿、扩血管药物的同时,早期静脉给予山莨菪碱（６５４－２     

蝮蛇咬伤局部十字形点刺处理的临床分析

2000-2005年作者采用中医传统局部处理救治和中药内服治疗蝮蛇咬伤1269例,其中采用本所研究使用于临床床30余年的十字形局部点刺法,配合中药治疗2h内的蛇伤急诊者690例,效果好,现报告如下。     

蛇伤解毒汤治疗蛇伤感染性溃疡56例体会

我院蛇伤诊所自１９９０年５月至１９９８年８月用蛇伤解毒汤治疗蛇伤患者５６例,疗效满意,现报告如下。１　临床资料　　蛇伤感染性溃疡５６例中男３８例,女１６例,其中五步蛇咬伤７例,蝮蛇咬伤９例,烙铁头蛇咬伤１３例,竹叶青蛇咬伤１１例,银环蛇咬伤１０例,溃疡时间最长２个月,最短１３天,平均３６５天。２　治疗　　蛇伤解毒汤组成：半边莲３０ｇ,大蓟白茅根各１５ｇ,大黄１２ｇ（后下）,无明粉１２ｇ（吞服）,车前子、白芷、夏枯草、野菊花、蒲公英各１２ｇ,蜈公虫３条,全蝎三只,加水煎服。服药１剂,大便通畅后,…     

蛇伤清毒合剂治疗蝮蛇咬伤临床观察

目的观察蛇伤清毒合剂治疗蝮蛇咬伤的临床疗效。方法将82例蝮蛇咬伤患者随机分为对照组和治疗组,对照组给予常规治疗,治疗组在常规治疗的基础上加服蛇伤清毒合剂。观察比较两组止痛时间、肿胀消退时间、疗程时间及两组患者局部坏死发生率、呼吸肌麻痹、急性肾功能衰竭发生率。蛄果蛇伤清毒合剂治疗组能缩短止痛时间、肿胀消退时间-减少局部坏死发生率、呼吸肌麻痹、急性肾功能衰竭发生率,与对照组比较差异显著（P〈0．05）。蛄论蛇伤清毒合剂能显著提高蝮蛇咬伤的疗效。     

中华眼镜蛇咬伤致组织肿胀坏死的中西医结合治疗研究

目的探讨桂中桂北蛇伤基地自主研发的蛇伤灵内服Ⅰ方、外敷Ⅱ方联合早期程序化综合治疗方法对中华眼镜蛇咬伤患者的局部组织坏死与肢体肿胀的临床治疗效果及机制。方法制定蛇伤皮肤组织坏死相关的客观临床评分标准,将纳入研究的60例患者随机分为蛇伤灵方联合早期程序化综合治疗组和早期程序化综合治疗对照组,每组各30例,观察比较两组患者在皮肤组织坏死积分及患肢肿胀程度方面的临床效果。结果治疗组患者的皮肤组织坏死积分与患肢肿胀程度明显低于对照组,组间比较差异具有显著性统计学意义(P0.05)。结论中西医结合治疗方法具有优越性,蛇伤灵方联合早期程序化综合治疗对中华眼镜蛇咬伤所致肢体肿胀、组织坏死程度的效果优于早期程序化综合治疗方法。     

解毒散与蛇伤合剂治疗蝮蛇咬伤2000例

蝮蛇咬伤在我国南方农村夏秋季中相当多见,该病发病急,病势演变快,易在短期内出现一系列的中毒症状,如不及时抢救,危及生命。我院应用解毒散外敷、蛇伤合剂内服治疗蝮蛇咬伤已有４０余年,现对１９９２～１９９７年收治的２０００例患者,进行疗效分析,现报道如下。...     

中华眼镜蛇伤致局部组织损伤治疗的实验研究

目的 探讨中华眼镜蛇伤致局部组织损伤的最佳治疗方法。方法 用中华眼镜蛇毒作家兔局部组织损伤模型,分别采用抗蛇素血清局部注射、糜蛋白酶局部注射、蛇伤药酒外敷、坏死组织早期切除、局部烧灼法、局部组织切开冲洗,共6种处理方法进行局部治疗,观察其疗效。结果 6种治疗方法从优到劣依次是：抗蛇毒血清局部注射、糜蛋白酶局部注射、蛇伤药酒外敷、坏死组织早期切除、局部烧灼法、局部组织切开冲洗。结论 中华眼镜蛇伤致局部组织损伤的治疗方法应首选抗蛇毒血清局部注射和糜蛋白酶局部注射,其次选用蛇伤药酒外敷。     

中西医结合治疗蝮蛇咬伤并心肌损害45例

目的探讨中西医结合治疗蝮蛇咬伤致心肌损害的临床疗效。方法回顾总结我院2009年4月~2010年10月收治的蝮蛇咬伤致心肌损害患者45例,采用抗蝮蛇毒血清、激素、热毒宁、蛇伤解毒汤综合治疗并观察临床疗效。结果本组治愈43例,显效2例,平均住院天数9天。结论中西医结合治疗蝮蛇咬伤致心肌损害疗效肯定。     

蛇伤处用聚乙烯薄膜包扎草药外敷效果好

蛇伤处用聚乙烯薄膜包扎草药外敷效果好方泰然浙江省诸暨市应店街镇紫云初中３１１８１７１９９５年我对１４例蛇伤患者除内服中药外,患肢肿胀处以聚乙烯塑料薄膜包敷中草药,效果显著。《中国毒蛇学》记载：“外用敷药,经彻底排毒后,可用新鲜草药捣烂外敷,保持湿润。...     

中药保留灌肠治疗蛇伤70例

蛇伤是夏季常见的外科疾病 ,在治疗中应及时及早的进行排毒解毒。我院采用外治疗法中药保留灌肠 ,局部以针刺排毒和外敷解毒散治疗蛇伤 70例 ,取得了满意效果 ,现报告如下。1　临床资料1 .1　一般资料　本组 70例中 ,男 42例 ,女 2 8例 ,年龄 3 0～ 5 0岁 ;咬伤上肢 3 8例 ,咬伤下肢 3 2例 ;就诊时间最短 4h,最长 2天 ;咬伤蛇种 :焦尾青竹蛇咬伤 3 0例 ,龟壳花蛇咬伤 2 1例 ,烙铁头蛇咬伤1 7例 ,银环蛇咬伤 2例。 70例患者均有不同程度头晕、欲呕、胸闷、腹痛、大便不通或大便排解不畅、少尿色赤等表现。1 .2　治疗方法　方以大黄 60 g,白花…     

中华眼镜蛇咬伤致局部组织损伤三种疗法的临床疗效观察

目的对中华眼镜蛇咬伤致局部组织损伤的各种治疗方法进行疗效优劣比较,找出最佳治疗方法。方法总结我院569例中华眼镜蛇咬伤致局部组织损伤的各种治疗方法。结果治疗方法从优到劣依次是：抗蛇毒血清局部注射-糜蛋白酶局部注射-蛇伤药酒外敷-坏死组织早期切除-局部烧灼法-局部组织切开冲洗。结论中华眼镜蛇伤致局部组织损伤的治疗方法应首选抗蛇毒血清局部注射和糜蛋白酶局部注射,其次选用蛇伤药酒外敷。     

Novel Apigenin Based Small Molecule that Targets Snake Venom Metalloproteases

The classical antivenom therapy has appreciably reduced snakebite mortality rate and thus is the only savior drug available. Unfortunately, it considerably fails to shield the viper bite complications like hemorrhage, local tissue degradation and necrosis responsible for severe morbidity. Moreover, the therapy is also tagged with limitations including anaphylaxis, serum sickness and poor availability. Over the last decade, snake venom metalloproteases (SVMPs) are reported to be the primary component responsible for hemorrhage and tissue degradation at bitten site. Thus, antivenom inability to offset viper venom-induced local toxicity has been a basis for an insistent search for SVMP inhibitors. Here we report the inhibitory effect of compound 5d, an apigenin based molecule against SVMPs both in silico and in vivo. Several apigenin analogues are synthesized using multicomponent Ugi reactions. Among them, compound 5d effectively abrogated Echis carinatus (EC) venom-induced local hemorrhage, tissue necrosis and myotoxicity in a dose dependant fashion. The histopathological study further conferred effective inhibition of basement membrane degradation, and accumulation of inflammatory leucocytes at the site of EC venom inoculation. The compound also protected EC venom-induced fibrin and fibrinogen degradation. The molecular docking of compound 5d and bothropasin demonstrated the direct interaction of hydroxyl group of compound with Glu146 present in hydrophobic pocket of active site and does not chelate Zn²⁺. Hence, it is concluded that compound 5d could be a potent agent in viper bite management.     

Bites by foreign venomous snakes in Britain.

In 1970-7 17 people in Britain were the victims of 32 bites by foreign venomous snakes. Crotalus atrox caused eight of these bites, Bitis arietans five, and the remaining 19 bites were caused by 12 different species. All the victims were bitten while handling the snake, and 24 bites were incurred by private individuals in their own homes. Poisoning was negligible in 17 of the 32 bites but life-threatening in at least two cases. Thus in the early stages snake bite may be unpredictable as a clinical problem. All victims of snake bite should be observed for at least 12 hours to assess the severity of poisoning and to ensure rational treatment. Local necrosis developed in six cases and resulted in prolonged illness in five of these cases; local incision was carried out and many have been a casual factor. Comprehensive stocks of antivenoms for treating bites by foreign venomous snakes are held by the National Health Services in Liverpool and London. Antivenom is indicated (a) for potentially serious systemic poisoning, as evidenced by hypotension, electrocardiographic changes, neurtrophilia, and acidosis (after viper or elapid bites), abnormal bleeding or non-clotting blood after viper bites; and ptosis or glossopharyngeal palsy after elapid bites; and (b) for bites from snakes whose venom causes local necrosis, to prevent or minimise this unpleasant complication. For effective antivenom treatment intravenous infusion is mandatory.     

Venomous snakebites in southern Croatia

This retrospective study is based on the analysis of 542 snakebite envenomation cases in southern Croatia, which were treated in the University Hospital Split over the period of 21 years. The aim of this study was to determine the incidence of venomous snakebite in southern Croatia, epidemiological and clinical features of snakebite and treatment in the region. The mean annual snakebite incidence in southern Croatia was 5.2 per 100,000 inhabitants. The nose- horned viper (Vipera ammodytes) was responsible for most bites, only a small proportion being inflicted by the adder (Vipera berus). People of all ages were affected (1 - 82 year old), but the bites were more frequent in individuals older than 50 (46% of the cases) and in children and adolescents 19 year old and younger (27% of the cases). Most snakebite accidents happened in warm spring and summer months, the highest number occurring in May (22%). A majority of the victims were rural people engaged in agricultural activities. Bites on the upper limbs were more frequent (57%) than bites on the lower limbs (42%). With regard to envenomation severity, there were 15.1% minor, 40.5% mild, 26% moderate and 18% severe cases. Two victims died (0.4%). The antivenom produced by the Institute of Immunology in Zagreb was given to virtually all patients, and complications following its administration were rare. The antivenom was used more often than it was suggested by the symptoms present.     

Angiostatin-like molecules are generated by snake venom metalloproteinases

Angiostatin is a plasminogen-derived anti-angiogenic factor composed of its first four kringle structures. This molecule is generated by proteolytic cleavage of plasminogen by some proteolytic enzymes in vitro. Since venoms of viper snakes are a rich source of both serine- and metalloproteinase, we hypothesized that angiostatin-like polypeptides could be generated during the envenomation after snake bites and play a pathophysiological role in the local tissue damage and regeneration. Our results showed that crude venoms from several species of Bothrops snakes were able to generate angiostatin-like polypeptides and purified metalloproteinases but not serine proteinases from Bothrops jararaca and Bothrops moojeni venoms were responsible for their generation in vitro. The putative plasminogen cleavage sites by the crude venoms and purified proteinases were determined by N-terminal amino acid sequencing of the angiostatin-like molecules. Angiostatin-like peptides derived from human plasminogen digestion by jararhagin, a metalloproteinase isolated from B. jararaca venom, inhibited endothelial cell proliferation in vitro. These results indicate that angiostatin-like molecules can be generated upon snakebite envenomations and may account for the poor and incomplete regenerative response observed in the damaged tissue.     

蛇伤性溃疡中西医结合高压氧治疗的体会

目的总结中西医结合高压氧治疗蛇伤性溃疡的临床疗效。方法对我院收治的27例蛇伤性溃疡患者在全身支持治疗、伤口局部清创、外用及湿敷中药治疗外,并给予高压氧治疗。结果 27例蛇伤性溃疡患者均治愈出院,治愈率100%。结论中西医结合高压氧治疗蛇伤性溃疡的疗效确切,值得临床借鉴及推广。     

The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone

Lower-extremity wounds with exposed tendon, bone, or orthopedic hardware present a difficult treatment challenge. In this series of patients, subatmospheric pressure therapy was applied to such lower-extremity wounds. Seventy-five patients with lower-extremity wounds, most of which were the result of trauma, were selected for this study. Dressings made of sterile open-cell foam with embedded fenestrated tubing were contoured to the wound size and placed into the wound. The site was covered with an adhesive plastic sheet. The sheet was placed beneath any external fixation devices, or the fixation device was enclosed within the sheet. The tubing was connected to the vacuum-assisted closure pump. Continuous subatmospheric suction pressure (125 mmHg) was applied to the wound site. The wounds were inspected and the dressings were changed every 48 hours.Vacuum-assisted closure therapy greatly reduced the amount of tissue edema, diminishing the circumference of the extremity and thus decreasing the surface area of the wound. Profuse granulation tissue formed rapidly, covering bone and hardware. The wounds were closed primarily and covered with split-thickness skin grafts, or a regional flap was rotated into the granulating bed to fill the defect. Successful coverage was obtained without complication in 71 of 75 patients. Wounds have been stable from 6 months up to 6 years.     

Knowledge of health workers on snakes and snakebite management and treatment seeking behavior of snakebite victims in Bhutan

BackgroundPublished information on snakebite is rare in Bhutan although remarkably higher number of snakebites and associated deaths are reported from other South Asian countries.Aims and methodologyStructured questionnaire was used to collect knowledge of health workers in snakebite management and health seeking behavior of snakebite victims as observed by health workers. Study was conducted in purposively sampled 10 Dzongkhags (district level administrative units) with higher incidence of snakebites.ResultHeath workers scored 27–91% (with an average of 63%, SD = 14) for 52 questions related to snake identification and snakebite management. Among 118 health workers interviewed, 23% had adequate knowledge on snakes and snakebite management while 77% had inadequate knowledge. Among 32 Doctors, 63% of them scored above or equal to 75%. Health workers from Sarpang scored higher (76%, SD = 11) than those from other Dzongkhags. Snakebite victim''s visit to local (traditional) healers prior to seeking medical help from hospital was observed by 75 (63%) health workers. Fifty one percent of health workers observed patients treated with local methods such as the use of black stone called Jhhar Mauro (believed to absorb snake venom), application of honey, rubbing of green herbal paste made up of Khenpa Shing (Artemisia myriantha Wallich ex Besser var. paleocephala [Pamp] Ling) and consumption of fluid made up of Neem leaf (Azadirachta indica Juss). Use of tight tourniquet as a first aid to snakebite was observed by 80% of the health workers.ConclusionHealth workers lack confidence in snakebite management. Snakebite victims are likely to suffer from harmful local practices and traditional beliefs on local treatment practices. Empowering health workers with adequate knowledge on snakebite management and making locals aware in pre-hospital care of snakebites are needed to improve the pre- and in-hospital management of snakebite in Bhutan.     

Identification of potent inhibitors against snake venom metalloproteinase (SVMP) using molecular docking and molecular dynamics studies

Snake venom metalloproteinase (SVMP) (Echis coloratus (Carpet viper) is a multifunctional enzyme that is involved in producing several symptoms that follow a snakebite, such as severe local hemorrhage, nervous system effects and tissue necrosis. Because the three-dimensional (3D) structure of SVMP is not known, models were constructed, and the best model was selected based on its stereo-chemical quality. The stability of the modeled protein was analyzed through molecular dynamics (MD) simulation studies. Structure-based virtual screening was performed, and 15 potential molecules with the highest binding energies were selected. Further analysis was carried out with induced fit docking, Prime/MM–GBSA (ΔG_Bind calculations), quantum-polarized ligand docking, and density functional theory calculations. Further, the stability of the lead molecules in the SVMP-active site was examined using MD simulation. The results showed that the selected lead molecules were highly stable in the active site of SVMP. Hence, these molecules could potentially be selective inhibitors of SVMP. These lead molecules can be experimentally validated, and their backbone structural scaffold could serve as building blocks in designing drug-like molecules for snake antivenom.