蜂蜇伤所致多器官功能损害临床随机对照研究

Randomized control clinical trial in multi-organ dysfunction by bee sting

目的:比较常规治疗与血液灌流(HP)、血液灌流联合连续肾脏替代疗法(HP+CRRT)治疗蜂蜇伤所致多器官功能损害.方法:蜂蜇伤导致多器官功能损害患者24例,拒绝行HP,CRRT的患者分为对照组(n=8),其余的16位患者采用随机数字表方法,随机分为HP,HP+CRRT组,每组8例.观察各组治疗前后的肾功能、肝功能、C反应蛋白(CRP)、肌酸激酶(CK)、肌酸激酶同功酶(CK-MB)变化.比较各组间的治愈率、死亡率、平均住院天数.结果:常规治疗组中2例患者死亡,病死率为25.0%(2/8),其余患者平均住院天数为(17.8±2.3)d,治愈率为62.5%(5/8),HP组平均住院天数为(10.6±1.9)d,HP联合CRRT为(8.3±1.3)d,P<0.05,后两者治愈率分别为87.5%,100.0%.结论:HP联合CRRT较常规治疗组或单用HP组更能有效治疗蜂蜇伤所致多器官功能损害,促进肾功能、肝功能、心肌酶谱改善,从而缩短病程,减少平均住院天数.

AIM： To analyze and compare the effect of conventional therapy, hemoperfusion or hemoperfusian combined with continuous renal replacement therapy （CRRT） to treat multi-or-gan dysfunction by bee sting. METHODS： Twenty-four patients with bee sting-caused multi-organ dysfunction were studied. The 8 patients who refused hemoperfusion or CRRT were put in conventional therapy group, and the other 16 patients were put to HP group or HP ＋ CRRT group by random digits table （ n = 8, respec-tively）. Renal function, hepatic function, CRP, creatine kinase and MB isoenzyme of creatine kinase were detected before and after treatment, and the recovery rate, the average hospital days and fatality rate were compared. RESULTS： Two cases died in con- ventional group, with the fatality rate 25.0% （ 2/8 ）, recovery rate 62.5% （5/8） and the average hospital days （ 17.8±2.3）d. The average hospital days were respectively （10.6±1.9 ） d and （8.3±1.2）d in HP group and in HP ＋ CRRT. Recovery rate in HP and HP combined with CRRT was 87.5% and 100.0%, respectively. CONCLUSION： HP combined with CRRT is the most effective in treating multi-organ dysfunction by bee sting a- mong the three therapeutic methods under study. HP combined with CRRT better improves renal function, hepatic function, creatine kinase and MB isoenzyme of creatine kinase, and shortens the hospital days.