Clinical Research On Small Incisions Combined With Negative Pressure Wound Therapy After Snakebite

Background:Snakebite is a common emergency,it presents high disability rate and fatality rate but is neglected in many countries and regions.A huge number of snakebite caused huge impact in China.At present,antivenoms is considered to be the specific management to snakebite,but it has many limitations in clinical use,such as the lack of antivenom and the adverse reactions caused by antivenom.Absorption rate and the total amount of snake venom is the key factor which decides the success of treatment.Incisions in the site of the bite for detoxinfication must be carried out in a short time.The content of toxin dis charged by single incision and natural gravity drainage is very low.The continuous absorption of venom contributs to the local and systemic toxicity reaction.If the effective methods to control the toxin absorption and to exclude the poison couldn't be taken at the early time of snakebite as soon as possible,systemic and local complications are likely to happen,which contribute considerable perniciousness to human body.Treatment of snakebite in China started in the folk,there is no corresponding expert consensus or guidelines to follow.Most medical institutions take the comprehensive conservative medical treatment or combine traditional Chinese medicine treatment,which existed many deficiencies.Incisions in the site of the bite may cause the damage of tendon,nerve or vessel,and may incease the infection rate.This kind of management dosen't significantly improve the prognosis.The adoption of negative pressure wound therapy in the areas of trauma or others became mature gradually.The advantage of NPWT lies in the effective drainage of the local inflammation effusion and exudates and composition of tissue necrosis,and in removement of the continuing impact by the mentioned substances.After all it eases th local inflammation accelerately.However,this technology was rarely used on snakebite treatment.Cupping therapy of traditional Chinese medicine in the treatment of snakebite has achieved marked success.It has the similar principle of negative pressure wound therapy.Hereby we designed this study,which injects the thought of cupping therapy into the negative pressure wound therapy on the snakebite treatment,using minimally invasive small incisions to explore the method of technical solution processes,and to observe the clinical effects and its effect on the local and systemic inflammatory response.Objective:To explore the methodology of small incisions combined with negative pressure wound therapy and the evaluation method of clinical effects on snakebite treatment.And to analysis the regulation of limb swelling and cytokines associated with systemic inflammatory response,to evaluate the effects of small incisions and negative pressure wound therapy on limb swelling and inflammatory response induced by snakebite.To explore the new idea and strategy of early snakebite treatment.Methods:Select 50 hospitalized patients bitten by viper from April 2015 to November 2016 in emergency department of Southwest Hospital,the Third Military Medical University.According to the inclusion criteria,patients were randomly divided into control group and observation group.Give corresponding treatment according to the grouping situation.Control group was given conventional comprehensive treatment,while besides,observation group was treated with the VSD after a surgery in proximal limb skin by multiple small incision.Patients' general indicators were record on admission.At the initial time of treatment,and in 6h,12 h,24h,48 h and 72 h after treatment,the perimeter of injured limb on the proximal,middle and distal sites,and the corresponding site of the unaffected limb were measured and recorded to calculate the difference values.At the time points,the plasma concentration of IL-6,TNF-?,IL-10 and Endocan were detected.Record and compare the incidence of complications and the length of hospital stay.Results:1.Swelling level in middle and proximal limb has positively correlation with interval of injury.The latter the interval is,The more serious the limb swelling(r=0.313,0.331;p= 0.028,0.020).The Doweny classification is positively correlated with interval of injury.The latter the interval is,the higher the level of classification is,so the the more serious injury presents.2.Significance differences are found in the differences of the perimeter of injured limb to the unaffected limb between the observation group and the control group,with the former obviously lower than the latter group at all the time points(P<0.05).3.Significance differences are found in the incidence of complications.The observation group is lower than the control group(P<0.05).the length of hospital stay in observation group is 5.44±0.89 days,and 7.71±1.70 days in control group.There is a significance differences between two groups,observation group is shorter than the control group(P<0.05).4.Significance differences are found in concentration of IL-6 between the observation group and the control group at different time points,observation group is lower than the control group(P<0.05).the same result presents in concentration of TNF-?.5.there is no significance differences in concentration of IL-10 between observation group and control group at different time points(P>0.05),the same result presents in concentration of Endocan.6.At the initial time of treatment the level of IL-6 is not correlated with interval of injury and Downey classification.The level of TNF-? has negative correlation with interval of injury but positive correlation with Downey classification.The earlier the inrterval of injury is,the higher the level of TNF-? presents.The higher the level of classification is,the higher the level of TNF-? presents.The level of IL-10 has negative correlation with interval of injury.The earlier the inrterval of injury is,the higher the level of IL-10 presents.The level of Endocan has positive correlation with interval of injury and Downey classification.The later the inrterval of injury and the higher the level of classification is,the higher the level of Endocan presents.Conclusion:1.Patients induced by snakebite present a tend of diversification.Limb swelling and systemic inflammatory response are observed after injury.Severity of injury is aggravating with the extension of the interval of injury.Try to get to the medical institutions after snakebite in the first time has important significance in first aid,which should be strengthen publicity.2.Measuring and recording to calculate the difference values of the perimeter of injured limb on the proximal,middle and distal sites,and the corresponding site of the unaffected limb,which can evaluate the degree of swelling during the treatment of snakebite.Small incisions combined with negative pressure wound therapy after snakebite can effectively accelerate the limb swelling detumescence and shorten the length of hospital stay.The recent curative effect is obvious.3.The systemic inflammatory responses can be reflected b y the the plasma concentration of IL-6,TNF-?,IL-10 and Endocan before treatment.Small incisions combined with negative pressure wound therapy after snakebite can effectively control the local release of inflammatory mediators,and accelerate systemic inflammatory response remission.4.Small incisions combined with negative pressure wound therapy after snakebite will not increase the risk of other complications during treatment.While it can reduce the skin tension,alleviate the local oppression,and drainage local necrotic tissue and cell component.Therefore,after snakebite giving small incisions with negative pressure wound therapy is safe and useful.