秦巴山区蜂蜇伤中毒407例临床分析

Clinical analysis of 407 cases of bee stings in Qinba mountain areas

目的：分析秦巴山区蜂蜇伤中毒的临床特征、治疗转归,为正确防治蜂蜇伤中毒、提高抢救成功率提供参考。方法：选取1997-01-2013-12在湖北省竹山县人民医院及县域内其他医疗机构住院治疗的蜂蜇伤中毒患者407例,对发病时间、蜇伤针数、临床表现、辅助检查、治疗方案及预后转归等临床资料进行回顾性分析。结果：1蜂蜇伤中毒发病具有明显的季节性,主要集中在9~11月,占75.43%;2蜂蜇伤中毒的临床表现复杂多样,可累及全身多个器官,易出现多器官功能不全,重要脏器损害发生率从高到低依次为肝、心、肾;3蜜蜂组、胡蜂组和大黄蜂组过敏症状的发生率差异无统计学意义（P〉0.05）,胡蜂组和大黄蜂组头晕头痛、心肌损害、肝功能异常、肾功能不全、多器官损害的发生率高于蜜蜂组（P〈0.05或P〈0.01）;4血液净化组病死率低于非血液净化组（P〈0.05）。结论：蜂蜇伤中毒抢救成功的关键：一是早期积极有效的抗过敏、抗休克治疗;二是早期血液净化治疗;三是早期重视和治疗多脏器功能损害。

Objective：To analyze the clinical demonstrations,treatment and outcome of bee stings in Qinba mountain areas,and to provide experience to prevent and cure of bee stings.Method：407cases of bee stings diagnosed in Hospital of ZhuShan County,Hubei Province from January 1997 to December 2013 were reviewed.Retrospective analysis was performed with the following indicators：onset time,the number of stings,clinical manifestation,auxiliary examination,therapeutic regimens and prognosis.Result：1The incidence of bee sting was observed mainly from September to November,accounting for 75.43%.2Clinical manifestation of bee stings poisoning was of considerable complexity and variability.Multiple organs could be impaired and it was prone to induce multiple organs dysfunction syndrome.The incidence of insult of liver,heart and kidney was from high to low as ranked sequentially.3There was no significant difference for the incidence of anaphylactic symptoms amongst the bee group,wasp and hornet group（P〉0.05）.The incidence of dizziness,headache,cardiac lesions,liver dysfunction,renal failure,multiple organs impairment was higher in wasp group and hornet group than that of bee group（P〈0.05 or P〈0.01）.4 Mortality of the hemodialysis group was significantly lower than that of non-hemodialysis group（P〈0.05）.Conclusion：To succeed in salvaging the intoxication of bee stings,it was crucial to treat anaphylaxis and shock effectively in prophase.Executing blood purification as soon as possible,taking preventive haemodialysis and taking measures to protect the vulnerable organs are needed.