不同血液净化模式治疗蜂蛰伤所致急性肾损伤患者的疗效分析

Curative effect analysis of different mode of blood purification on acute kidney injury following multiple bee stings

目的：探讨不同血液净化模式治疗蜂蛰伤所致急性肾损伤（AKI）患者的疗效。方法回顾性分析本院2008年6月至2012年12月收治的287例急性蜂蛰伤中毒患者，135例（47%）出现AKI，其中117例采用血液净化治疗，将此117例患者分为三组，观察治疗效果差异：①连续性静脉-静脉血液滤过（CVVH）＋血液灌流（HP）/间歇性血液透析（IHD）组47例，入院后使用HA330血液灌流器进行血液灌流治疗2小时，灌流结束后行CVVH治疗24-72小时，情况稳定后给予IHD治疗；②IHD＋HP组52例，采用Gambro AK200S血液透析机行血液透析，并在透析机前串联HA330血液灌流治疗，每次治疗2小时，每周3-5次；③IHD组18例，IHD每周3-5次。对比三组患者预后情况、生化指标变化以及住院时间，使用SPSS 17.0软件进行统计学分析。结果①CVVH＋HP/IHD组：43例患者（91.5%）好转出院，4例患者（8.5%）死亡；②IHD＋HP组：41例患者（78.8%）好转出院，7例患者（13.5%）死亡，4例患者（7.7%）自动出院失访；③IHD组：10例患者（55.5%）好转，5例患者（27.8%）死亡，3例患者（16.7%）自动出院失访。CVVH＋HP/IHD组及IHD＋HP组患者的生存率及临床好转率无显著差异，但与IHD组比较差异具有显著性，且CVVH＋HP/IHD组患者的生化指标好转较IHD＋HP组更快，治疗时间更短。结论 CVVH＋HP/IHD及IHD＋HP均能够有效治疗蜂蛰伤所致AKI患者，但CVVH＋HP/IHD病情控制更快速，是蜂蛰伤所致AKI的首选治疗方式。在无连续性血液净化条件的基层单位，也可采取IHD＋HP方式，达到有效治疗的目的。

Objective To investigate the curative effect of different mode of blood puriifcation on acute kidney injury following multiple bee stings. Method 287 patients with bee stings injury from June 2009 to December 2014, were retrospective analysised, in which 135 cases （47%） suffered acute kidney injury （AKI）, 117 cases with AKI were administered blood puriifcation. The 117 patients were divided into three groups： ①CVVH＋HP/IHD group：intervention of HA330 hemoperfusion after hospitalized, 2 hours later, continuous veno-venous hemoifltration （CVVH） during 24 - 72 hours was performed, and then intermitent hemodialysis （IHD） was administered when conditions of patients were stable; ②IHD＋HP group：IHD was performed 3-5 times per week, intervention of HA330 hemoperfusion was performed in the ifrst three hemodialysis; ③IHD group：IHD was performed 3-5 times per week. Compared the prognosis, biochemical indicator and length of stay. Result ①CVVH＋HP/IHD group：43 cases （91.5%） improved and discharged, while 4 cases （8.5%） died;②IHD＋HP group：41 cases （78.8%） improved but 7 cases （13.5%） died, and 4 cases （7.7%） were automatic discharged; ③IHD group：10 cases （55.5%） improved but 5 cases （27.8%） died, and 3 cases （16.7%） were automatic discharged. There were no signiifcant differences of survival and clinical improvement rates between CVVH＋HP/IHD and IHD＋HP groups, but there was statistical signiifcance when comparing CVVH＋HP/IHD and IHD＋HP with IHD groups. The rate of improvement in CVVH＋HP/IHD was faster than IHD＋HP group, and the length of stay was shorter. Conclusion CVVH ＋ HP/IHD and IHD ＋ HP are useful for curing the patient with acute kidney injury following multiple bee stings, but CVVH＋HP/IHD controlled the disease more rapidly, which is the preferred way. However, where the continuous blood puriifcation machine is shortage, the primary health care units can get achieve effective treatment through IHD＋HP.