中华眼镜蛇伤致局部组织损伤的临床研究

目的 探讨中华眼镜蛇咬伤致局部组织损伤的最佳治疗方法。方法 对蛇伤患者分别采用蛇伤药酒外敷、胰蛋白酶或糜蛋白酶局部封闭、抗眼镜蛇毒血清局部封闭共3种处理方法进行局部治疗,观察其疗效。结果 3种治疗方法从优到劣依次是：抗眼镜蛇毒血清局部封闭、胰蛋白酶或糜蛋白酶局部封闭、蛇伤药酒外敷。结论 中华眼镜蛇咬伤致局部组织损伤的治疗方法应首选抗眼镜蛇毒血清局部封闭,其次是胰蛋白酶或糜蛋白酶局部封闭,最差的是采用蛇伤药酒外敷。     

蛇伤药酒抗毒抗菌作用的实验研究

目的探讨蛇伤药酒抗眼镜蛇毒、内毒素及细菌的效果。方法抗眼镜蛇毒和内毒素试验采用鲎试剂法．抗菌试验采用纸片法。结果眼镜蛇毒与0．5EU／ml鲎试剂产生凝集反应的浓度在5．0ug／ml以上;蛇伤药酒浓度1ml／ml时有抗5倍量眼镜蛇毒的凝集反应;有抗2．5倍量内毒素的凝集反应;对多种细菌有抑制作用。结论蛇伤药酒有抗眼镜蛇毒、抗内毒素和多种病原菌的作用。     

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。     

蛇伤药酒体外抗5种蛇毒的实验研究

目的探讨蛇伤药酒抗五步蛇、竹叶青蛇、眼镜蛇、蝰蛇、蝮蛇蛇毒的效果。方法采用鲎试剂试管凝集反应法。结果蛇伤药酒浓度为1.0 ml/ml时,对5种蛇毒均有破坏产生凝胶反应的作用;浓度为0.5ml/ml时,对五步蛇、竹叶青蛇、眼镜蛇蛇毒有破坏产生凝胶反应的作用;浓度为0.3 ml/ml时,仅对五步蛇毒有破坏产生凝胶反应的作用;浓度降至0.1 ml/ml时,对5种蛇毒均无破坏产生凝胶反应的作用。结论蛇伤药酒有较好的抗蛇毒作用,且对五步蛇毒作用最强。     

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。     

中华眼镜蛇毒致局部组织损伤的动物实验研究

目的对中华眼镜蛇毒致局部组织损伤的6种治疗方法,通过动物实验进行疗效优劣比较,找出最佳治疗方法。方法用中华眼镜蛇毒制作动物家兔局部组织损伤模型,分别采用6种不同的治疗方法进行局部治疗,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．     

眼镜蛇咬伤临床研究概况

正眼镜蛇别名扁头风、蝙蝠蛇、扇头风等,为我国常见剧毒蛇之一。眼镜蛇蛇毒是以血循毒为主的混合毒,其毒素中所含的磷脂酶A2(PLA2),可诱导细胞凋亡[1]。被眼镜蛇咬伤后常引起局部组织水肿、坏死,形成溃疡后久治不愈,影响局部正常功能,严重者甚至截肢,导致患者丧失生活劳动能力,降低生活质量。因此,如何提高眼镜蛇伤患者的救治水平成为越来越迫切需要解决的问题。现将眼镜蛇咬伤临床研究治疗概况综述如下。     

应用蛇伤镇痛酊的临床观察

毒蛇咬伤致局部肿胀剧痛,是蛇伤科临床常见症状之一,而目前国内治疗蛇伤后局部消肿镇痛外用药物品种甚少,且消肿镇痛效果欠佳。因此,作者在祖传药酒镇痛的基础上进一步改进,在几百味中草药中筛选出有效经验方——蛇伤镇痛酊。主要用于治疗毒蛇咬伤引起的伤口局部肿胀疼痛,也可治疗风湿性关节炎、类风湿性关节炎、痛风、急性软组织挫伤、陈旧性挫伤、带状疱疹后遗症、中风后遗症等,经对2342例蛇伤患者及646例慢性疑难病症患者的临床观察,疗效显著,现报告如下。     

眼镜蛇咬伤的发病机理和诊治

眼镜蛇主要分布于我国长江以南各省,有关全国各地6436例蛇伤病例统计结果,眼镜蛇咬伤占蛇伤发病率的第二位(16.68％),仅次于蝮蛇咬伤(34.37％),病死率1.6％。然而不同的地区发病率不尽相同,邓氏报道(1989)广西河池地区1973年至1985年共收集蛇伤病1人4781例,     

古蔡氏法测定蛇伤药酒中砷盐含量

目的建立蛇伤药酒的砷盐含量测定方法。方法采用古蔡氏法测定砷盐含量。结果古蔡氏法能有效测出蛇伤药酒的砷盐,砷含量约为240μg/ml。结论该方法简便、可靠,可用于蛇伤药酒砷盐的测定。     

眼镜蛇伤模型造模探讨及多项指标的动态观察

目的 探讨眼镜蛇伤模型的造模方法并观察模型多项指标的动态变化。方法 用中华眼镜蛇毒于家兔左小腿作皮下注射制作眼镜蛇伤模型,并分别于注蛇毒前1天,注蛇毒后6h,24h和7天从家兔耳缘静脉采血作血液和生化等多项指标的检查。结果 与生理盐水组相比,眼镜蛇毒组的家兔在注毒后数小时至24h可出现炎症反应和急性弥漫性血管内凝血(DIC),心功能及水盐代谢亦受到一些影响。结论 利用家兔可制作出眼镜蛇伤模型。     

Delayed psychological morbidity associated with snakebite envenoming

Introduction

The psychological impact of snakebite on its victims, especially possible late effects, has not been systematically studied.

Objectives

To assess delayed somatic symptoms, depressive disorder, post-traumatic stress disorder (PTSD), and impairment in functioning, among snakebite victims.

Methods

The study had qualitative and quantitative arms. In the quantitative arm, 88 persons who had systemic envenoming following snakebite from the North Central Province of Sri Lanka were randomly identified from an established research database and interviewed 12 to 48 months (mean 30) after the incident. Persons with no history of snakebite, matched for age, sex, geograpical location and occupation, acted as controls. A modified version of the Beck Depression Inventory, Post-Traumatic Stress Symptom Scale, Hopkins Somatic Symptoms Checklist, Sheehan Disability Inventory and a structured questionnaire were administered. In the qualitative arm, focus group discussions among snakebite victims explored common somatic symptoms attributed to envenoming.

Results

Previous snakebite victims (cases) had more symptoms than controls as measured by the modified Beck Depression Scale (mean 19.1 Vs 14.4; p<0.001) and Hopkins Symptoms Checklist (38.9 vs. 28.2; p<0.001). 48 (54%) cases met criteria for depressive disorder compared to 13 (15%) controls. 19 (21.6%) cases also met criteria for PTSD. 24 (27%) claimed that the snakebite caused a negative change in their employment; nine (10.2%) had stopped working and 15 (17%) claimed residual physical disability. The themes identified in the qualitative arm included blindness, tooth decay, body aches, headaches, tiredness and weakness.

Conclusions

Snakebite causes significant ongoing psychological morbidity, a complication not previously documented. The economic and social impacts of this problem need further investigation.     

What the snake leaves in its wake: Functional limitations and disabilities among snakebite victims in Ghanaian communities

BackgroundThe estimated five million snakebites per year are an important health problem that mainly affect rural poor populations. The global goal is to halve both mortality and morbidity from this neglected tropical disease by 2030. Data on snakebite morbidity are sparse and mainly obtained from hospital records.MethodsThis community-based study was conducted among 379 rural residents with or without a history of snakebite in the Ashanti and Upper West regions of Ghana. All participants in the snakebite group were bitten at least six months before the day of survey. The World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0) and the Buruli Ulcer Functional Limitation Score were used to obtain patient-reported measure of functioning and disability. Long-term consequences were evaluated based on the severity of the symptoms at the time of the snakebite.FindingsThe median (IQR) time since the snakebite was 8.0 (3.5–16.5) years. The relative risk of disability was 1.54 (95% CI, 1.17–2.03) in the snakebite group compared to the community controls. Among patients with clinical symptoms suggesting envenoming at the time of bite, 35% had mild/moderate disabilities compared to 20% in the control group. The disability domains mainly affected by snakebite envenoming were cognition level, mobility, life activities and participation in society. A combination of the severity of symptoms at the time of the bite, age, gender and region of residence most accurately predicted the odds of having functional limitations and disabilities.ConclusionThe burden of snakebite in the community includes long-term disabilities of mild to moderate severity, which need to be considered when designing appropriate public health interventions. Estimating the total burden of snakebite is complicated by geographic differences in types of snakes and their clinical manifestations.     

毒蛇咬伤的早期预测与程序化救治的疗效观察

目的通过对毒蛇咬伤的早期预测和处理,评价程序化综合救治方法对毒蛇咬伤的疗效。方法对136例毒蛇咬伤患者除进行“毒蛇咬伤的临床病情分型”外,尽早进行病情预测、血生化(肝、肾功能、凝血功能、心肌酶)检查,同时进行伤口和全身程序化综合救治。观察病情变化,伤口愈合情况及平均住院时间。结果总有效率100％,无过敏反应发生,伤口渗血、肿胀明显缓解,平均住院时间较前缩短。结论早期准确预测和尽快应用程序化救治方法能提高对毒蛇咬伤的疗效。     

Rediocides A and G as Potential Antitoxins Against Cobra Venom

Rediocides A and G, the principle components of Trigonostemon reidioides (Kurz ) Craib , which is known as Lotthanong in Thai, were investigated for a detoxification mechanism against Naja kaouthia venom by in silico, in vitro, and in vivo methods. Molecular dockings of α‐cobratoxin with rediocides A and G were performed, and the binding energies were found to be ?14.17 and ?14.14 kcal/mol, respectively. Rediocides bind to α‐cobratoxin at the same location as α‐cobratoxin binds to the nicotinic acetylcholine receptor (nAChR), i.e., at the Asp27, Phe29, Arg33, Gly34, Lys35, and Val37 residues. α‐Cobratoxin cannot bind to nAChR, because some of its binding sites are occupied with rediocides. From in vitro SDS‐PAGE, it was found that rediocides can diminish the bands of α‐cobratoxin. In the presence of acetylcholine‐binding protein (AChBP), it was apparent that rediocides can bind both α‐cobratoxin and AChBP. From an in vivo test, it was found that injection of rediocides at 0.5 mg/kg immediately after an α‐cobratoxin dose of three times LD₅₀ cannot prolong the survival time of mice. However, rediocide can prolong the survival time, if it is injected 30 min before the injection of α‐cobratoxin. The in vitro SDS‐PAGE and the in vivo results support the in silico detoxification mechanism of rediocides against cobra venom at a molecular level.     

双黄蛇伤散治疗竹叶青蛇咬伤96例体会

目的探讨双黄蛇伤散对竹叶青蛇咬伤的临床疗效．方法将96倒竹叶青蛇咬伤患者随机分为治疗组和对照组各48侧,均给予常规治疗,治疗组加外敷双黄蛇伤散．结果两组息肢肿胀开始消退时间、肿胀完全消退时间、疼痛缓解时间和住院时间比较均有极显著性差异（P〈0．01）．治疗组局部坏死和功能受限发生事与对照组比较均有极显著性差异（P〈0．01）．结论双黄蛇伤散外敷治疗竹叶青蛇咬伤有显著疗效．     

蜂胶酊对金黄色葡萄球菌性阴道炎疗效观察

目的探讨蜂胶酊对小鼠阴道内致病菌抑制及调理阴道菌群的作用。方法通过感染金黄色葡萄球菌建立小鼠阴道炎模型,用10％蜂胶酊冲洗治疗去除金黄色葡萄球菌在小鼠阴道的定植。倾注培养法（37℃,48h）计数阴道分泌物的细菌总数,镜下观察阴道黏膜炎症程度。结果蜂胶酊治疗组小鼠阴道内细菌的数量明显较对照组数量减少（P〈0．05）,治疗组黏膜炎症的治愈程度显著好于对照组。结论蜂胶酊对小鼠金黄色葡萄球菌性阴道炎有较好的治疗效果。     

银环蛇咬伤致急性呼吸衰竭的治疗及临床观察

目的观察抗银环蛇毒血清和机械通气对银环蛇咬伤致急性呼吸衰竭的疗效。方法应用抗蛇毒血清和机械通气救治23例银环蛇咬伤致急性呼吸衰竭患者。结果银环蛇咬伤患者及早应用抗银环蛇毒血清,毒蛇咬伤后发生急性呼吸衰竭时间为2.5～16h。当患者出现睁眼困难、吞咽困难、呼吸节律改变或呼吸困难时,即予气管插管行机械通气,可获得较好的疗效。结论机械通气辅助抗蛇毒血清是救治银环蛇咬伤致呼吸衰竭有效的方法。     

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。