甲基强的松龙对重症蜂蜇伤患者的治疗分析

Clinical Observation of Large Dose of Methylprednisolone in Patient with Severe Wasp Sting

目的:探讨甲基强的松龙冲击对重症蜂蜇伤患者血清中细胞因子和器官功能的影响。方法:随机将69例重症蜂蜇伤患者分为治疗组38例与对照组31例,2组均给予器官功能支持为主的综合治疗;治疗组前3 d予以甲基强的松龙0.5 g/d静脉滴注。观察2组患者0 h、2 h血清中肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、IL-8的水平;入院0 h、72 h器官功能损害程度及病死率。结果:0 h时,2组TNF-α、IL-6和IL-8水平差异无统计学意义(P>0.05);而2 h时差异均有统计学意义(P<0.01)。0 h时,2组患者器官功能损害程度差异无统计学意义(P>0.05);72 h时,治疗组患者器官功能损害程度明显低于对照组,差异有统计学意义(P<0.05);治疗组治愈率(97.4%)明显高于对照组(83.9%),差异有统计学意义(P<0.05)。结论:炎性细胞因子在蜂蜇伤患者多器官功能损害中起了重要作用;甲基强的松龙冲击治疗可以明显减轻蜂蜇伤继发的损伤,降低蜂蜇伤急性期病死率,改善预后。

Objective： To investigate effects of methylprednisolone plus therapy on serum cytokine levels and organ function for severe bee stings. Methods： Sixty-nine patients with wasp sting were randomly divided into treatment group （n= 38） and control group （n=31）. Patients were given organ support combined therapy in two groups. Methylprednisolone was given intravenous infusion of 0.5 g/d for the first three days in treatment group. The expression levels of tumor necrosis factor （TNF）-a, interleukin （IL）-6 and IL-8 were detected at 0 h and 2 h respectively in two groups. The changes of organ damage and the death rate were evaluated at 0 h, 72 h after admitted to hospital respectively. Results： The expression levels of TNF-a, IL-6 and IL-8 at 0 h were no significant differences between two groups （P 〉 0.05）, but there was a significant difference at 2 h between two groups（P 〈 0.01）. There was no significant difference in the organ damage at 0 h between two groups （P 〉 0.05）. The organ damage was significantly lower at 72 h in treatment group than that of control group （P 〈 0.05）. The recovery rate was significantly higher in treatment group （97.4%） than that of control group （83.9%, P 〈 0.05）. Conclusion： Inflammatory cytokines play an important role in the multiple organ dysfunction caused by wasp stings. Methylprednisolone pulse therapy can significantly reduce the secondary damage caused by acute wasp sting, reduce the mortality and improve the long-term prognosis.