CAJ | 학술논문

目的：探讨血循毒类毒蛇咬伤患者早期伤口切开对预后的影响。方法回顾性分析我院2011年3月～2014年3月诊治的血循毒类毒蛇咬伤患者223例的临床资料，总结并比较其临床特点及预后。结果本组患者轻度肿胀97例中，伤后12 h内切开21例，未溃疡12例，Ⅰ°溃疡7例，Ⅱ°溃疡2例；晚期切开或未切开76例，未溃疡15例，Ⅰ°溃疡41例，Ⅱ°溃疡16例，Ⅲ°溃疡4例。中度肿胀患者85例中，伤后12 h内切开32例，未溃疡8例，Ⅰ°溃疡21例，Ⅱ°溃疡2例，Ⅲ°溃疡1例；晚期切开或未切开53例，未溃疡6例，Ⅰ°溃疡16例，Ⅱ°溃疡24例，Ⅲ°溃疡7例。重度肿胀患者41例中，伤后12 h内切开17例，Ⅰ°溃疡11例，Ⅱ°溃疡4例，Ⅲ°溃疡2例；晚期切开或未切开24例，Ⅰ°溃疡2例，Ⅱ°溃疡6例，Ⅲ°溃疡16例。在蛇伤后12 h内切开的患者坏死溃疡的形成、肿胀程度的改善均明显优于晚期切开或未切开的患者，差异有显著统计学意义（ P＜0.05）。结论随着患者凝血功能的改善，早期伤口切开对血循毒类毒蛇伤患者局部伤口状况有较好的改善作用。
목적：탐토혈순독류독사교상환자조기상구절개대예후적영향。방법회고성분석아원2011년3월～2014년3월진치적혈순독류독사교상환자223례적림상자료，총결병비교기림상특점급예후。결과본조환자경도종창97례중，상후12 h내절개21례，미궤양12례，Ⅰ°궤양7례，Ⅱ°궤양2례；만기절개혹미절개76례，미궤양15례，Ⅰ°궤양41례，Ⅱ°궤양16례，Ⅲ°궤양4례。중도종창환자85례중，상후12 h내절개32례，미궤양8례，Ⅰ°궤양21례，Ⅱ°궤양2례，Ⅲ°궤양1례；만기절개혹미절개53례，미궤양6례，Ⅰ°궤양16례，Ⅱ°궤양24례，Ⅲ°궤양7례。중도종창환자41례중，상후12 h내절개17례，Ⅰ°궤양11례，Ⅱ°궤양4례，Ⅲ°궤양2례；만기절개혹미절개24례，Ⅰ°궤양2례，Ⅱ°궤양6례，Ⅲ°궤양16례。재사상후12 h내절개적환자배사궤양적형성、종창정도적개선균명현우우만기절개혹미절개적환자，차이유현저통계학의의（ P＜0.05）。결론수착환자응혈공능적개선，조기상구절개대혈순독류독사상환자국부상구상황유교호적개선작용。
Objective To investigate the optimal timing of surgical incision for patients with blood circulation of snakebite . Methods 223 blood circulation of snakebite patients in our hospital from March 2011 to March 2014 were reviewed and retrospectively analyzed .To summarize and compare the clinical features and prognosis . Re‐sults According to the degree of swelling and ulcers in patients with wound classification .97 patients with mild swelling ,21 patients was performed surgical incision within 12 hours after injury ,12 patients without ulcers ,7 pa‐tients with Ⅰ°ulcers ,2 patients with Ⅱ°ulcer ,no patients with Ⅲ°ulcer ;76 patients with advanced incision or no in‐cision wound ,15 patients without ulcers ,41 patients with Ⅰ°ulcers ,16 patients with Ⅱ°ulcer ,4 patients with Ⅲ° ulcer .85 patients with moderate swelling ,32 patients was performed surgical incision within 12 hours after injury , 8 patients without ulcers ,21 patients with Ⅰ°ulcers ,2 patients with Ⅱ°ulcer ,1 patients with Ⅲ°ulcer ;53 patients with advanced incision or no incision wound ,6 patients without ulcers ,16 patients with Ⅰ°ulcers ,24 patients withⅡ°ulcer ,7 patients with Ⅲ°ulcer .41 patients with severe swelling ,17 patients was performed surgical incision within 12 hours after injury ,no patients without ulcers ,11 patients with Ⅰ°ulcers ,4 patients with Ⅱ°ulcer ,2 pa‐tients with Ⅲ°ulcer ;24 patients with advanced incision or no incision wound ,no patients without ulcers ,2 patients with Ⅰ°ulcers ,6 patients with Ⅱ°ulcer ,16 patients with Ⅲ°ulcer .Compared with the advanced incision or no inci‐sion patients ,patients was performed surgical incision within 12 hours after injury ,their necrotic ulcers and swell‐ing degree of improvement was dominant ,the difference was statistically significant (P< 0.05) . Conclusion With the improvement of coagulation function ,early wound incision on patients with blood circulation of snakebite local wound condition have a better effect .