序贯性血液净化治疗蜂中毒并多器官功能障碍综合征疗效分析

Efficacy analysis of sequential blood purification treatment of bee poisoning complicated by multiple organ disfunction syndrome

目的探讨序贯性血液净化方法治疗马蜂蜇伤致蜂中毒并多器官功能障碍综合征（MODS）的疗效。方法对武汉市儿蕈医院11例马蜂蜇伤并MODS的患儿进行序贯性血液净化治疗，中毒早期及时给予血浆置换（PE）、血液灌流（HP）清除毒素，同时序贯连续性肾脏替代治疗（CRRT），疾病好转期进行间断血液透析（IHD），不同时期应用不同净化模式治疗。采用回顾性分析的方法观察患儿治疗前后肝。肾功能、心肌酶谱等变化趋势，总结血液净化治疗的效果。结果11例患儿中10例予HP、CRRT和IHD治疗，6例在入院第1天进行PE治疗。1例年龄最小的患儿在入院不到24h因中毒性心肌炎突发心律失常死亡。10例患儿经治疗心肌酶谱首先恢复正常，其次，黄疸和肝功能好转，治疗10d后肾功能逐渐好转。出院2周后回访复查肝肾功能、心肌酶谱各项指标完全恢复正常。尿常规复查5例患儿有镜下血尿，3例有血尿并蛋白尿，2例尿常规完全正常。好转治愈率为91％（10／11例）。结论早期及时采用多种血液净化模式序贯治疗是救治重症蜂中毒并MODS患儿的主要有效的手段。

Objective To study the efficacy of sequential blood purification treatment of bee poisoning compli- cated by multiple organ disfunction syndrome （MODS）. Methods The ll cases of children with bee poisoning and MODS from Wuhan Children＇s Hospital were treated with sequential blood purification therapy, and they were treated with plasma exchange （ PE ）, hemopeffusion （HP） and sequential continuous renal replacement therapy （CRRT） simultaneously in the early stage ,and then were treated with intermittent hemodialysis （IHD）in the remission stage. Different modes of purification treatment were applied in different stages. The trends of liver function, renal function and myocardial enzymes were observed in 1 lcases before and after therapy,later a retrospective analysis was performed,and the efficacy of sequential blood purification was studied. Results Ten in 11 cases of children were treated with HP, CRRT and IHD therapy, and among them 6 cases were treated with PE on the first day of admission. One case,the youn- gest of children admitted to hospital tess than 24 hours, died of sudden cardiac arrhythmia due to toxic myoearditis. In ten cases of the children after treatment, their myocardial enzymes returned to normal at first, and then jaundice and hepatic tunction improved, and renal function gradually improved after 10 days. Two weeks after discharge, through reviewing of the liver and kidney function, myocardial enzymes returned to normal indicators. In review of urine,5 cases were accompanied with microscopic hematuria,3 cases were accompanied with hematuria and proteinuria, and 2 cases were completely normal. The improved cure rate was 91% （ 10/11 cases）. Conclusions Sequential blood purification treatment is the main and effective means for severe bee poisoning complicated with MODS in children in the early stage.