Research On Clinical Features And Pathogenesis Of Hemorrhagic Snake Venom And Its Differences With Dic

Objective To investigate the strategy of clinic character and emergency treatment strategy with rednecked keelback snakes hurt, trimeresurus stejnegeri, Long-noded pit viper after encoding fibrinolysin metalloproteinase from the bite of the clinical characteristics and pathogenic mechanism and emergency management policies, provides a more reasonable basis for clinical diagnosis and treatment.Methods Select7emergency patients have been bitten by rednecked keelback snakes,12emergency patients have been bitten by trimeresurus stejnegeri bite,4emergency patients have been bitten by Long-noded pit viper analysis clinical features and treatment methods and the differences between18confirmed cases of DIC secondary to other disease patients。Results In7cases bitten by rednecked keelback snakes,6(85.71%) cases appears heavier bleeding tendency; The most serious occurs after the bite0-48h;4cases of patients die (66.67%). Dynamic observation of discovery, The peak time of blood coagulation function exception occurs in24～48h after being bitten. PT appears extended, lower Fg, D-D and3P-positive, but as the time gone by the indexes of the abnormal rate of decline, the average of HGB,PLT had no exception;12patients bitten by trimeresurus stejnegeri, The most serious occurred in0-48h after bitten;Only one trimeresurus stejnegeri appears in hemorrhagic shock. All patients with no other organ without serious dysfunction after hemorrhagic shock and no death. Dynamic observation of discovery, The peak time of blood coagulation function exception occurs in24-72h after being bitten. PT appears extended, lower Fg, D-D and3P-positive, but as the time gone by the indexes of the abnormal rate of decline, the average of HGB,PLT had no exception;4cases of patients bitten by encoding fibrinolysin metalloproteinase have heavy bleeding. The most serious occurred in0-48h after been bitten; All patients with no other organ without serious dysfunction after hemorrhagic shock and no death. Dynamic observation of discovery, The peak time of blood coagulation function exception occurs in24-72h after being bitten. PT appears extended, lower Fg, D-D and3P-positive, but as the time gone by the indexes of the abnormal rate of decline, the average of HGB,PLT had no exception; Shock rate up to78.6%, with high death rate (57.89%). The peak time of blood coagulation function exception occurs in96h after hospital admission。PT appears extended, lower Fg, D-D and3P-positive, but as the time gone by the indexes of the abnormal rate with no decline, HGB,PLT average is significantly lower than the normal range, and there is a downward trend.Conclusion Rednecked Keelback Snake, trimeresurus stejnegeri and encoding fibrinolysin metalloproteinase from snake bites lead to dysfunction of blood coagulation in patients with non-typical of DIC, venom-induced consumption coagulapathy. Three kinds of snake bites have significant differences in patients with DIC on the clinical. patients bitten by hemorrhagic snake with no obvious fibrin deposition,microvascular thrombotic obstruction,and resultant end-organ damage or organ failure.patients bitten by three kinds of snakes lack the typical high coagulation DIC (PT and APTT extend shortening), into the early onset of expendable low pour point and soon secondary hyperfibrinolysis. This is the greatest differences between patients with hemorrhagic patients bitten by snakes and DIC. On the prognosis of disease, different types of snakes with different venom toxicity, there are significant differences of clinical characteristics of patients with snake bites, mainly the severity changes fast and rapid progress complex hemorrhage as the main manifestation, including red neck high mortality of patients bitten by snakes, bitten by trimeresurus stejnegeri bite and encoding fibrinolysin metalloproteinase with the lower death rate, prognosis is better. Disease progress faster than patients bitten by snake in patients with DIC, based on the different underlying diseases, treatment effects are different, but mortality is relatively high Because the patient’s main clinical manifestation is bleeding, so we should minimize injury of vein puncture in the treatment process, avoid invasive operations on it, such as deep venous catheter, artery, etc. Clinical observation of the patients should accept more than3days at least. Treatment in patients with hemorrhagic patients bitten by snakes and DIC should be added in fresh frozen plasma and blood coagulation factors, and different in patients with other causes of DIC, if there are no obvious clinical basis for micro-thrombus embolism, vasodilator drugs such as654-2or to be careful in the use of vasoactive drugs.