Clinical Study Of Mannitol In Treating Limb Swelling Of Snake Bite Patients

Background:Snake bites often occur in the hot summer and autumn season,and the bite is mostly located at the end of the extremities,which is one of the common clinical emergencies.In recent years,due to the warming of the climate,snake bite patients in Sichuan increased gradually,and most of them came from rural and mountainous areas.The common venomous snakes in Sichuan area include Agkistrodon halys,Trimeresurus mucrosquamatus,Trimeresurus stejnegeri,Ancistrodon acutus,Vipera russelli siamensis and so on.Among them,Agkistrodon halys are the most common,so the patients are also mainly bitten by Agkistrodon halysThe severity of a snake bite is related to the type of snake,the amount of venom,the location of the injury,medical treatment time,and the patient's own condition.The stronger the toxicity of snake venom,the greater the amount of venom,the later the treatment,the worse the basic condition,and the bite of trunk,head,neck,will lead to the more serious codition of the patient.The venom of Trimeresurus mucrosquamatus,Trimeresurus stejnegeri,Ancistrodon acutus and Vipera russelli siamensis is mainly blood-toxin,while the Agkistrodon halys has both neurotoxicity and blood-toxin,and the mainly venom of Agkistrodon halys is blood-toxin Blood-toxin can cause local limb swelling,bleeding,necrosis,and even serious complications such as osteofascial compartment syndrome and amputation.With the widespread use of antivenom serum,the mortality rate of patients caused by snake bites is gradually reduced,and the limb swelling and complications caused by snake bites has become one of the main problems in clinical treatment.After the snake bite,the swelling of the limb develops rapidly,involving the whole affected limb,and even extending to the ipsilateral chest and abdomen.The mechanism is:(1)Snake venom contains a variety of enzymes,and its proteolytic enzyme can directly damage the capillary endothelial cells and destroy the integrity of the blood vessel wall,causing increased vascular permeability,extravasation of plasma,leading to local tissue hemorrhage,necrosis and edema;(2)Hyaluronidase in snake venom can dissolve cells and fibrous interstitial,destroy the integrity of connective tissue,and promote snake venom rapid spread and absorption from the bite to the surrounding;(3)After the snake venom acts on the body,it can stimulate the body to release kinins,histamine and 5-hydroxytryptamine,causing increased vascular permeability,leading to plasma exudation and limbs swellingAt present,the limb swelling caused by snake bites has been paid much attention by many scholars.Existing treatment schemes are constantly improved and new treatment methods are being explored,but the therapeutic effect is not satisfactory.Most of the snake bite patients still have local limb swelling when they are discharged from the hospital.The duration of swelling is even 3?4 months or longer,which seriously affects the patient's study,life and work.Therefore,it is of important clinical significance to actively treat limb swelling caused by snake bitesMannitol has tissue dehydration and osmotic diuresis,and has a wide range of clinical applications.However,there is no report on the therapeutic effect of mannitol on limb swelling caused by snake bite.In this study,mannitol was used in the treatment of limb swelling in snake bite patients.To investigate the mechanism of mannitol on limb swelling of snake bite patients and to observe the therapeutic effectObjective:(1)To explore the mechanism and therapeutic effect of mannitol in relieving limb swelling of snake bite patients,and to observe whether mannitol can alleviate limb pain,reduce the incidence of osteofascial compartment syndrome,infection,surgery,amputation,and whether it can shorten the duration of limb swelling peak and hospital stay(2)To explore whether mannitol has effects on WBC,hsCRP,PLT,APTT,PT,CK-MB,IBIL,MYO,and Cr.(3)To explore whether there is a correlation between limb swelling and WBC,hsCRP,MYO,CK-MB,PT,IBIL and PLTMethods:Sixty patients with snake bites in our hospital from May to October 2018 were selected and approved by the Medical Ethics Committee of the Affiliated Hospital of North Sichuan Medical College.They were numbered according to the order of admission and table of random numbers were used to generate random numbers.For the control group(group A)and the observation group(group B),30 patients in each group.Group A patients were given basic antivenom serum treatment.Group B patients were treated with mannitol 125ml,q8h,intravenous infusion for 4 days on the basis of basic treatment.Observed and compared the limb swelling,pain index,WBC,hsCRP,PLT,APTT,PT,CK-MB,IBIL,MYO,Cr,duration of swelling peak,hospital stay,and infection,osteofascial compartment syndrome,surgery,amputation between the two groupsResults:1.General information of patients:there was no significant difference between group A and group B in sex,age,elevation,weight,time of treatment,location of injury and degree of swelling(P>0.05).2.Limb swelling and regression:After admission to hospital,the limb swelling of the two groups of snake bite patients was still aggravated,and the swelling peak was reached at 24h.The swelling of the limbs in group B was significantly lower than that in group A at 48h,72h and 96h(P<0.05).3.Pain index:There was no significant difference in pain index between group A and group B at Oh and 24h(P>0.05).The pain index of group B was lower than that of group A at 48h,72h and 96h(P<0.05).4.Limb swelling and related complications:The duration of swelling peak and hospital stay in group B were significantly shorter than that in group A,and the surgery rate was significantly lower than that in group A(P<0.05).There was no significant difference in the incidence of infection in group A and group B(P>0.05).Patients with osteofascial compartment syndrome and amputation did not appear in either group A or B.5.Blood monitoring indicators:Snake venom can lead to the elevated of White blood cells,Hypersensitive C-reactive protein,Creatine kinase isoenzyme,Myohemoglobin,Prothrombin time,Activated partial thromboplastin time and Indirect bilirubin and the decrease of platelet,There was significant difference in WBC,hsCRP,MYO,ck-mb and IBIL between group B and group A(P<0.05).There was no significant difference in PLT,PT,APTT and Cr between group B and group A(P>0.05).6.Correlation of limb swelling:The results of the study showed that limb swelling was positively correlated with WBC,hsCRP,MYO,CK-MB,PT and IBIL(r values were0.832?0.817?0.803?0.802?0.667?0.777).The limb swelling was negatively correlated with PLT(r value was-0.589).Conclusion:1.Mannitol can reduce limb swelling in patients with snake bite,relieve pain,reduce operation rate,shorten duration of swelling peak and hospital stays.2.Limb swelling was positively correlated with WBC,hsCRP,MYO,CK-MB,PT,IBIL,and negatively correlated with PLT,the blood monitoring indicators can be used to preliminarily assess the limb swelling and severity of the disease.