“蛇头都断了，还能咬人……”诸暨72岁的张大爷（化名）躺在病床上，看着好不容易保住的手臂，眼眶泛红。
“他不是被一条蛇咬伤的，而是被眼镜蛇的蛇头咬伤，一度生命垂危。”经过浙江省中医院急诊、重症、普外科、护理等多学科团队共同努力，在手术、抗蛇毒血清、中药等中西医结合治疗下，张大爷成功保住了性命，也保住了被咬的左手。
眼镜蛇资料图 图源：VCG
A 72-year-old man in East China's Zhejiang province survived a life-threatening cobra bite after being bitten by the severed head of the venomous snake he had killed, with doctors ultimately saving his injured arm.
5分钟后蛇头突然“复仇”
5月一个下午，老钓友张大爷在河边钓鱼时闯入一条眼镜蛇的“地盘”。他认为退缩反而更危险，想起《亮剑》里的经典台词——狭路相逢，勇者胜！便抄起随身携带的挖土铲，连续两次击打眼镜蛇，将蛇头铲断。
眼镜蛇被杀死了，蛇头也已经不会动了，张大爷便用手去捡。就在他左手触碰蛇头的一刹那，已断离约5分钟的蛇头猛然张开嘴巴，毒牙狠狠刺入他的掌心。
The man, surnamed Zhang, encountered a cobra while fishing by a riverside in May. After killing the snake and severing its head with a shovel, he reached down to pick it up about five minutes later when the detached head suddenly bit his left palm.
“就像被电击了一下，疼得我‘啊’一声，接着看到蛇头还死死咬着不放。”张大爷回忆。他用力甩掉蛇头，急忙往医院赶，伤口很快发黑肿胀，不到20分钟就开始胸闷、眼花、恶心呕吐。强撑到当地医院紧急处理后，迅速转至浙江省中医院钱塘院区急诊医学科。
His hand quickly turned black and swollen, and within 20 minutes he developed chest tightness, blurred vision, nausea and vomiting. After initial treatment at a local hospital, he was transferred to Zhejiang Provincial Hospital of Traditional Chinese Medicine.
神经毒、细胞毒双重侵袭
入院时，张大爷左手从拇指到肩膀，已经肿得像紫茄子，咬伤处皮肤发黑坏死，局部温度明显升高。他表情痛苦，呼吸急促，心电监护显示心率120-130次/分、血压持续降低至80/42mmhg。急诊医生检查后发现，患者出现眼睑下垂、视物模糊、吞咽困难等神经毒性症状，同时肌酸激酶5979U/L,降钙素原17.269μg/L等指标飙升——这是典型的眼镜蛇毒液引发的“神经-细胞-心脏”三重中毒，若不及时救治有生命危险。
于是，医院当即启动绿色通道，张大爷立刻被推进抢救室进行抢救，同时使用蛇毒血清，完善术前准备。
手术清创
抢在坏死蔓延之前
蛇伤救治资深专家王永高主任主刀，迅速实施“左上肢肌肉筋膜切开减压术、上肢静脉取栓术、创面封闭式负压引流术”。术中发现，左手掌大鱼际咬伤处周围及手背皮肤变黑，范围约10cm*7cm及12cm*12cm，左上肢张力极高，皮下组织坏死，桡动脉微弱，术中检测到前臂骨筋膜室压力竟高达61mmHg。
“蛇毒导致的组织坏死就像火势蔓延，必须彻底烧掉‘焦木’才能保住整棵树。”医生沿着咬伤灶向近心端扩大切口，彻底切除了坏死组织，反复用双氧水、碘伏和大量生理盐水冲洗，并放置VSD负压引流管妥善固定。经过普外科与重症医学科的共同努力，张大爷顺利度过重症阶段转回普通病房。
Doctors found he was suffering from severe cobra venom poisoning, affecting his nervous system, tissues and heart. He underwent emergency surgery as well as received antivenom and intensive multidisciplinary treatment.
但患肢感染重，张大爷仍要面对极高的截肢风险。因此普外科王城磊主治医师为其制定了系统的保肢方案。扩创引流、蚕食清创、负压技术、人工真皮移植……经过2个月的努力，创面修复成功，张大爷的左手保住了。
After two months of wound care and rehabilitation, doctors successfully saved his left hand.
头部离体
仍可通过脊髓反射进行攻击
浙江省中医院创面与血管外科学科专家王永高提醒，爬行动物头部离体后，仍可通过脊髓反射维持数十分钟甚至更长时间的攻击行为，蛇头咬合力和毒腺注射功能依然存在。
一旦被毒蛇咬伤，应记录蛇的特征（有条件的情况下最好拍照，以便医务人员辨认，提高治疗精准度），去除伤肢上的首饰和紧身衣物，保持静卧，尽快送往有抗蛇毒血清的医院。切忌用嘴吸、乱切伤口、敷草药或剧烈奔跑。
Doctors warned that a severed snake head can still bite through spinal reflexes for dozens of minutes or even longer. They advised anyone bitten by a venomous snake to remain still and seek immediate medical treatment rather than attempting self-treatment.
来源：橙柿互动·都市快报
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