Реферат
Objective:To investigate the clinical effect of low molecular weight heparin sodium combined with antivenin in the treatment of severe and critical bite by Trimeresurus stejnegeri.Methods:The clinical data of 48 patients with severe or critical bite by Trimeresurus stejnegeri admitted to emergency department of Southeast Hospital Affiliated to Xiamen University from March 2017 to May 2019 were retrospectively analyzed. On the basis of early treatment of antivenom serum, internal administration and external application of Jidesheng snake tablet, and wound incision and detoxification, the patients were divided into heparin treatment group and non-heparin treatment group according to whether the low molecular heparin sodium was used or not. The patients in the two groups were compared in terms of gender, age, clinical classification, swelling degree of injured limbs, change of coagulation function index, bleeding of skin, mucous membrane or digestive tract, blood transfusion, local symptoms of bite, length of hospital stay and prognosis.Results:There was no significant difference in terms of gender, age, clinical classification or swelling degree of injured limbs between the two groups. On the 3rd day of treatment, the platelet count (PLT) in the heparin treatment group was significantly higher than that in the non-heparin treatment group [×10 9/L: 210.0 (160.0, 252.0) vs. 136.0 (104.0, 198.5), P < 0.05]. However, there was no significant difference in the four coagulation test results between the two groups. On the 6th day of treatment, the plasma thrombin time (TT) in the heparin treatment group was significantly shorter than that on the 3rd day of treatment [s: 30.3 (20.4, 37.0) vs. 34.7 (24.0, 73.4), P < 0.05], and the fibrinogen (FIB) in the heparin treatment group was significantly higher than that in the non-heparin treatment group [g/L: 0.60 (0.31, 1.07) vs. 0.20 (0.14, 0.60), P < 0.01]. The incidence of bleeding in the heparin treatment group was significantly lower than that in the non-heparin treatment group [21.7% (5/23) vs. 64.0% (16/25), P < 0.01]; 11 patients in the heparin treatment group and 18 patients in the non-heparin treatment group received blood transfusion and prothrombin complex supplement respectively. There was no significant difference in the length of hospital stay between the heparin group and non-heparin treatment group (days: 6.91±1.92 vs. 7.48±2.27, P > 0.05). The patients in both groups were followed up for 1 week to 1 month after treatment, and no death or local necrosis of skin and soft tissue was found. Conclusions:For the patients with severe and critical bite by Trimeresurus stejnegeri, on the basis of injection of antivenom serum, internal administration and external application of Jidesheng snake tablet, and wound incision and detoxification, early application of low molecular weight heparin sodium anticoagulation and other comprehensive treatment is helpful to improve limb swelling and inflammation, reduce blood transfusion, promote the recovery of coagulation function, and shorten the length of hospitalization.
Реферат
Objective To compare the predictive value of CT severity index(CTSI)and modified CT severity index (MCTSI) for the severity and prognosis of acute pancreatitis (AP).Methods The clinical data of 72 patients with AP were retrospectively analyzed.The consistency between MCTSI,CTSI and revised Atlanta classification of AP-2012 was respectively compared by the Kappa test.The sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of the MCTSI and CTSI in differentiating severe acute pancreatitis (SAP) were calculated.The predictive value of MCTSI and CTSI for SAP and mortality was respectively analyzed by receiver operating characteristic (ROC)curve,and the area under the curve(AUC)was respectively calculated.Results The MCTSI and CTSI showed good agreement with the revised Atlanta classification of AP-2012(the Kappa statistic was 0.653 and 0.656 respectively).The sensitivity,specificity,PPV and NPV of MCTSI were 90.0%(18/20), 86.5% (45/52), 72.0% (18/25) and 95.7% (45/47) respectively; and those of CTSI were 50.0% (10/20), 96.2% (50/52), 83.3% (10/12) and 83.3% (50/60) respectively.The AUC of MCTSI for predicting SAP and mortality were 0.932 and 0.913 respectively, and of CTSI were 0.908 and 0.874 respectively.Conclusions The MCTSI and CTSI have a similar and good consistency in predicting severity of AP.However,the MCTSI shows more sensitive and accurate in predicting SAP and prognosis.