群蜂蛰伤致急性肾功能衰竭23例临床分析

Analysis of 23 Cases with Acute Renal Failure Caused by Hornet Venom

目的:提高群蜂蛰伤致急性肾衰竭(ARF)的诊断和治疗水平。方法:回顾性分析我科7年来收治的23例群蜂蛰伤致ARF的临床资料,初步探讨其疗效及死因等。结果:23例群蜂蛰伤致急性肾功能衰竭患者,少尿型ARF为20例(占87%)无尿型ARF为3例(占13%);均伴有心肌酶、肌酸激酶、乳酸脱氢酶、谷丙转氨酶(ALT)升高;主要并发症为中毒性心肌炎(23/23,100.0%)、横纹肌溶解肌症(23/23,100.0%)、血红蛋白尿(21/23,91.3%)、血管内溶血(21/23,91.3%)、中毒性肝炎(16/23,69.6%)等;入院后12h内,10例行血液透析(hemodialysis,HD),13例行血液灌流(he-moperfusion,HP)/透析联合治疗(HP/HD);两组患者总治愈好转率为87.0%,病死率为13.0%;其中HD组治愈好转率为70.0%(7/10),病死率为30%(3/10),HP/HD组治愈好转率为100%(13/13),病死率为0,两组间疗效存在显著差异(P=0.034);但所观察的病例中,HD组为我科前3年治疗蜂毒致ARF的方案,HP/HD组为我科后4年主要治疗蜂毒致ARF的方案,组间存在时间差异,并且病例数亦较少,因此两组的疗效对比有待进一步研究。3例患者死亡原因为多系统脏器功能衰竭(MSOF)。结论:蜂毒中毒所致急性肾功能衰竭以少尿型为主,同时伴有心、肝、血液、神经系统等重要组织器官的损伤,病情重;患者主要死亡原因为全身多系统器官功能衰竭(MSOF);尽早行血液净化是治疗群蜂蛰伤有效手段,其中条件允许的医院建议首选HP/HD联合治疗。

Objective.. To improve the diagnosis and treatment of acute renal failure （ARF） induced by hornet venom. Methods：Retrospective analysis 23 cases of ARF induced by hornet venom of recently 7 years, explore its cause of death and the efficacy healing method. Results：In these cases, 20 cases were oliguria type ARF, 3 cases were anuran type ARF. All case accompanied by enzymes, creative kinas, lactate dehydrogenate, calamine aminotransferase （ALT） increased. The main complications were viral myocarditis （23/23, 10G 0%）, rhabdomyolysis muscle disease （23/23, 100. 0%）, hemoglobinuria （21/23, 91.3 % ）, intravascular hemolytic （21/23, 91.3 % ）, toxic hepatitis （16/23, 69.6 % ）, etc. After admission for 12h, 10 cases exercise hemodialysis （hemodialysis, HD）, 13 cases exercise hemoperfusion / dialysis treatment （HP/HD）. Two groups of patients with efficient cure rates was 87.0%, mortality was 13.0%. HD treatment which efficient cure rate of 70. 0%（7/10）, mortality was 30% （3/10）, HP / HD group efficient cure rate was 100% （13/13）, mortality was 0, there was a significant difference in efficacy between the two groups （P=0. 034）. However, The first three years （2000-2002）, the HD were used to treated hornet venom-induced ARF, the next four years （2003-2007）, HP/HD was the main treatment method. There was time difference between groups, and only had a few cases, therefore, further study was required.The cause of death for three cases were multiple system organ failure （MSOF）. Results： Most of Acute renal failure induced by hornet venom was oliguria type, accompanied by heart, liver, blood, nervous system and other important organs injured. The leading cause of death for patients were multi-system organ failure （MSOF）. Blood purification therapy was the effective way to get rid of toxin of hornet venom from the blood, and HP / HD combination therapy was recommended.