蝮蛇解毒汤联合红光治疗蝮蛇咬伤伤肢肿胀临床研究

陈海东　龚旭初　陶菊

摘要：目的 探討蝮蛇解毒汤联合红光照射对蝮蛇咬伤患者伤肢肿胀的临床疗效及对炎症因子的影响。方法 采用随机数字表法将90例患者分为对照组和试验组各45例。对照组伤口消毒后予抗蝮蛇毒血清、抗生素、破伤风免疫球蛋白，并补充能量，纠正水、电解质紊乱。试验组在对照组治疗基础上予蝮蛇解毒汤，每次150 mL，每日2次口服；并在伤肢肿胀最明显处进行红光照射，每次20 min，每日2次。连续治疗6 d。观察2组治疗前后伤肢肿胀情况，检测血清C反应蛋白（CRP）、5-羟色胺（5-HT）、组胺、肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-6水平。结果 与本组治疗前比较，试验组治疗3、6 d及对照组治疗6 d患肢肿胀明显消退，差异有统计学意义（P<0.01）。与对照组同一时点比较，试验组治疗3、6 d患肢肿胀消退情况明显改善，差异有统计学意义（P<0.01）。与本组治疗前比较，2组治疗后CRP、5-HT、TNF-α、IL-6水平明显降低，差异有统计学意义（P<0.05）。试验组治疗后CRP、5-HT、组胺水平明显优于对照组（P<0.05）。结论 蝮蛇解毒汤联合红光治疗蝮蛇咬伤患者伤肢肿胀疗效显著，并可降低患者血清炎症因子水平。

关键词：蝮蛇解毒汤；红光治疗；炎症因子

DOI：10.3969/j.issn.1005-5304.2018.06.007

中图分类号：R269.462 文献标识码：A 文章编号：1005-5304（2018）06-0026-04

Clinical Observation of Viper Bites Injury Limb Swelling Treated by Fushe Jiedu Decoction Combined with Red Light

CHEN Hai-dong， GONG Xu-chu， TAO Ju， WU Jin-na， HONG Hong

Nantong Hospital of Traditional Chinese Medicine， Nantong 226001， China

Abstract： Objective To explore the efficacy of Fushe Jiedu Decoction combined with red light on viper bites injury limb swelling and the effects on the inflammatory cytokines. Methods Totally 90 patients were divided into control group and experimental group by using random number table method， with 45 cases in each group. The wounds of the control group were sterilized and given anti-snake venom serum， antibiotics， and tetanus immunoglobulin and supplemented with energy to correct water and electrolyte disturbances. The experimental group was treated with Fushe Jiedu Decoction based on the treatment of control group， 150 mL each time， orally， twice a day； Red light was applied at the site of the most obvious swelling of the injured limb， 20 minutes each time， twice a day. The treatment lasted for 6 d. The swelling of injured limbs， serum C-reactive protein （CRP）， 5-hydroxytryptamine （5-HT）， histamine， tumor necrosis factor-α （TNF-α）， interleukin （IL）-6 levels before and after treatment in the two groups were observed. Results Compared with before treatment， the swelling of the limbs disappeared significantly in the experimental group at 3 d and 6 d and in the control group at 6 d， with statistical significance （P<0.01）. Compared with the control group at the same time point， the swelling of the limbs in the treatment group was significantly better than that in the control group at 3 d and 6 d， with statistical significance （P<0.01）. Compared with before treatment， the levels of CRP， 5-HT， TNF-α， and IL-6 were significantly lower in the two groups， with statistical significance （P<0.05）. After treatment， CRP， 5-HT and histamine in the experimental group were significantly better than that in the control group （P<0.05）. Conclusion Fushe Jiedu Decoction combined with red light has good efficacy for viper bites injury limb swelling， which can reduce inflammatory cytokines levels of patients.

Keywords： Fushe Jiedu Decoction； red light treatment； inflammatory cytokines

基金项目：江苏省中医药局科技项目（ZD201510、YB2017064）

通讯作者：龚旭初，E-mail：gxcj0317@sina.com

蝮蛇是江、浙、皖地区分布最广的一种毒蛇，蝮蛇毒为神经、血循混合毒性，蝮蛇咬伤是灾害性外科急性疾病。患者病情变化快，中毒严重者易引起脏器功能损害甚至衰竭。随着抗蝮蛇毒血清问世，我们在传统医学基础上结合现代医学进一步提高了蝮蛇咬伤的治疗水平，使死亡率低于1%[1]。蝮蛇毒血清可中和游离毒素，但并不能快速缓解伤肢的肿胀及疼痛，而局部伤肢疼痛、肿胀易影响伤肢功能恢复，严重者有致残风险，已成为影响蝮蛇咬伤患者预后的主要因素[2]。本研究观察蝮蛇解毒汤联合红光治疗对蝮蛇咬伤患者伤肢肿胀消退的影响，现报道如下。……