不同剂量糖皮质激素联合血液灌流对蜂蛰伤所致多器官功能障碍综合征的影响

Effects of different doses of glucocorticoid combined with hemoperfusion on multiple organ dysfunction syndrome induced by bee sting injury

目的:探讨不同剂量糖皮质激素联合血液灌流(HP)治疗蜂蛰伤所致多器官功能障碍综合征(MODS)的疗效.方法:2017年6月~2018年6年我院收治的78例马蜂蜇伤并发MODS患者作为研究对象.采用随机数表法,将78例患者分为HP联合甲泼尼龙冲击治疗组(HMP)和HP联合常规大剂量甲泼尼龙组(HMC),每组39例.治疗前和治疗7d后观察以下指标:①生化指标:血肌酐(Scr)、尿素氮(BUN)、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、肌酸激酶同工酶(CK-MB)和血红蛋白(HGB)浓度.②血流动力学指标:心率(HR)、平均动脉压(MAP)、肺动脉楔压(PCWP)、心脏指数(CI)、体血管阻力指数(SVRI)、肺血管阻力指数(PVRI).③血清炎症因子C-反应蛋白(CRP)、白细胞介素(IL)-6.④采用序贯器官衰竭估计评分(SOFA)评价患者的预后.⑤患者进入多尿期的时间、肾功能完全恢复时间和住院时间.结果:治疗7d后,两组Scr、BUN、AST、ALT、CK-MB和HGB均明显改善,且HMP组的改善程度优于HMC组.两组HR、MAP、PCWP、CI、SVRI和PVRI均明显改善,且HMP组的改善程度优于HMC组.两组SOFA评分均明显下降,且HMP组低于HMC组.HMP组进入多尿期时间、肾功能恢复时间和住院时间较HMC组低.结论:与常规大剂量糖皮质激素治疗相比,冲击疗法有利于加快蜂蛰伤合并MODS患者器官功能的恢复,改善炎症水平,并缩短住院时间.

Objective To investigate the effects of different doses of glucocorticoid combined with hemoperfusion(HP)on multiple organ dysfunction syndrome(MODS)induced by bee sting injury.Methods From June 2017 to 2018,78 cases of bee sting combined with MODS were studied.78 patients were divided into HP combined with methylprednisolone pulse therapy group(HMP)and HP combined with routine high-dose methylprednisolone group(HMC),39 cases in each group.The following indexes were observed before and 7 days after treatment:(1)Biochemical indexes:serum creatinine(Scr),urea nitrogen(BUN),aspartate aminotransferase(AST),alanine aminotransferase(ALT),creatine kinase isoenzyme(CK-MB)and hemoglobin(HGB).(2)Hemodynamic parameters:heart rate(HR),mean arterial pressure(MAP),pulmonary wedge pressure(PCWP),cardiac index(CI),systemic vascular resistance index(SVRI),pulmonary vascular resistance index(PVRI).(3)serum inflammatory factors C-reactive protein(CRP)and interleukin(IL)-6.(4)sequential organ failure assessment(SOFA)was used to evaluate the prognosis of patients.(5)the time for patients to enter polyuria,the complete recovery time of renal function and the length of stay.Results After 7 days of treatment,Scr,BUN,AST,ALT,CK-MB and HGB were significantly improved in both groups,and the improvement degree of HMP group was better than that of HMC group.HR,MAP,PCWP,CI,SVRI and P VRI were significantly improved in both groups,and the improvement degree of HMP group was better than that of HMC group.The SOFA scores of the two groups were significantly decreased,and the HMP group was lower than that of the HMC group.Group HMP entered polyuria period,renal function recovery time and hospitalization time were lower than group HMC.Conclusion Compared with the conventional high dose glucocorticoid therapy,the impact therapy can accelerate the recovery of organ function,improve the level of inflammation and shorten the hospitalization time in patients with bee sting combined with MODS.