The Study On The Role Of Low Molecular Weight Heparin Calcium Combined With Aspirin On The Effect Of Local Necrosis Caused By Naja Naja Bites

Objective:(1)To obtain the epidemiological characteristics of Naja naja bites in Baise area.(2)To observe the intervention effect of subcutaneous injection of low molecular weight heparin calcium combined with oral aspirin on local necrosis caused by cobra bite.Methods:(1)Data of 279 patients with Naja naja bites admitted to the emergency department of Youjiang Medical College for Nationalities Affiliated Hospital from January 1,2017 to December 31,2022 were collected.(2)A prospective study was conducted on 50 hospitalized patients diagnosed with Naja naja bites from January 1,2021 to December 31,2022,who were randomly divided into two groups: 24 patients in the control group and 26 patients in the experimental group.The control group received conventional treatment,and the experimental group received subcutaneous injection of LMWHC combined with oral ASP on the basis of conventional treatment.Baseline data and disease data of patients were collected.This study was approved by the Ethics Committee of the Youjiang Medical College for Nationalities Affiliated Hospital and informed consent of patients and their families.Results:(1)The epidemiological survey results:(1)Baseline data:The most cases of Naja naja bites occurred in May.90.68% of patients visited the hospital within 24 hours after the bite.68.82% of the hospitalized patients were aged between 20 and 50,and male accounted for 90.32%.91.04% of patients were farmers.86.38% of the patients were from Baise city and its surrounding counties.Most of the patients were attacked by Naja naja at home or in the field,and most of the injuries occurred during the day.The bite was mainly on the upper limb.Naja naja bites are often accompanied by vomiting,diarrhea,pain,swelling,and necrosis.(2)Laboratory tests:30.69% of patients showed APTT decline.(3)Disease score:88.17% of patients with mild disease degree.76.29% of patients with local ulcer grade I.(2)Results of experimental research:(1)Baseline data: There were no statistically significant differences between the two groups in gender composition,age,bite site,bite location,time from bite to admission,severity of disease,swelling of the affected limb,pain index,objective clinical criteria score of skin necrosis,and necrotic area,upon admission,which were comparable.(2)Laboratory examination: There were statistically significant differences in PLT,Cr and PTbetween two groups.(3)Swelling: On the third day of admission,the experimental group was smaller than the control group,and the difference was statistically significant.(4)There was no significant difference in pain index,objective clinical criteria score of skin necrosis and ulcer grading between the two groups at the second day and the third day.(5)Necrotic area: local necrotic area was recorded at admission and at 6,12,24,48,72 hours after bite.The necrotic area reached its maximum at 12 hours after bite in the control group and 24 hours after bite in the experimental group.There was no significant difference in necrotic area between the two groups on admission,which could be compared.At 72 hours of bite,the necrotic area of the experimental group was smaller than that of the control group,and the difference between the two groups was statistically significant.(6)The progress of the necrosis: The progress of the necrosis at 6,12,24,48,72 hours and the total progress of the necrosis of the bite were calculated.In the control group,the necrotic area increased gradually from 6 hours to 12 hours,and decreased gradually from 12 hours to 24 hours.The necrotic area increased from 12 hours to 24 hours in the experimental group.The necrotic area did not increase 24 hours after the bite in both groups.The progress of the necrosis of the two groups was compared between groups.The progress of the necrosis of the experimental group was less than that of the control group at 48 hours and 72 hours of bite,but the progress of the necrosis of the experimental group was greater than that of the control group at 24 hours of bite.(7)Wound healing degree: there was no statistical significance in wound healing between the two groups.The patient was then transferred to the specialist or local hospital for further treatment,and the local wounds were all healed at a follow-up visit 3 months after discharge.Conclusion:(1)The majority of Naja naja bites patients in Baise area were male,middle-aged and elderly,and the incidence peaked in May.Most of the injured parts were concentrated in the upper limbs.Most of the patients arrived at the hospital within 24 hours after the bite,and most of them came to the hospital by themselves.The systemic symptoms were mostly digestive tract symptoms,while the local symptoms were pain,swelling and necrosis.The necrosis rate was as high as 69.53%.Laboratory tests showed that the blood was in a hypercoagulable state.The severity of the disease was mostly mild,the degree of local ulcer was mostly I degree.(2)Conventional treatment dose of LMWHC combined with ASP could improve the hypercoagulable state of blood in the cobra bite patients and the degree of swelling at the wound,and effectively slow down the progress of local necrosis and reduce the area of local necrosis.But could not completely change the outcome of local tissue necrosis in the bite.