序贯透析治疗海蜇蜇伤致心衰或伴多脏器功能衰竭28例临床观察

Clinical observation of the effect of sequential dialysis on heart failure or multi-organ failure induced by jellyfish sting in 28 cases

目的 观察序贯透析治疗海蜇蜇伤致心衰（HF）或伴多脏器功能衰竭（MOF） 28例患者的疗效.方法 2011-2014年海蜇蜇伤引起HF患者28例,其中,男22例,女6例,年龄6～ 64岁,平均（29.83 ±8.35）岁.16例伴急性肾衰竭（ARF）,8例伴休克,20例伴中心静脉压（CVP）增高,于序贯透析治疗前后以心脏多普勒超声作左室舒张末内径（LVEDd）、每搏输出量（SV）、心输出量（CO）测定和肾功能（BUN和SCr）以及CVP、血钾浓度检测,比较其结果.结果 28例治疗前后LVEDd分别是（65.00±5.51）mm和（35.00±1.42） mm,差异有统计学意义（t=7.16,P＜O.05）,SV分别是（54.00±2.21）mm和（76.00±6.33）mm,差异有统计学意义（t=4.42,P＜0.05）,LVEF分别是（42.80±3.71）％和（64.90±5.42）％,差异有统计学意义（t=5.91,P＜0.05）,CO分别是（2.93±0.95） L/min和（5.78±1.83） L/min,差异有统计学意义（t=2.3,P＜0.05）;16例伴ARF治疗前后BUN分别是（40.26 ±3.19） mmol/L和（6.15±1.03） mmol/L,差异有统计学意义（t=13.02,P＜0.05）,SCr分别是（256.00±11.76） μmol/L和（106.00±6.87） μmol/L,差异有统计学意义（=9.94,P＜0.05）,血钾浓度分别是（6.18±0.92） mmol/L和（4.02±0.13） mmol/L（t =3.09,P＜0.05）;20例伴CVP增高患者治疗前后CVP分别是（2.66±0.33） kPa和（1.19±0.14） kPa,差异有统计学意义（t=7.56,P＜0.05）.28例中5例死亡（17.86％）,23例治愈（82.14％）.结论 以序贯透析技术治疗海蜇蜇伤致HF或伴MOF可获明显疗效.

Objective To observe the therapeutic effect of sequential dialysis on heart failure （HF） and or multi-organ failure induced by jellyfish sting.Methods Enrolled in our study were 28 cases of jellyfish sting that occurred between 2011 and 2014.Of the 28 cases, 22 were male cases and 6 were female cases, with an age range of 6 to 64 years （29.83 ± 8.35）.Sixteen cases were accompanied with acute renal failure （ARF）, 8 cases with shock and 20 cases with increased central venous pressure （CVP）.The left ventricular end-diastolic diameter （LVEDd）, each stroke volume （SV）, cardiac output （CO）, blood urea nitrogen （BUN）, serum creatinine （Scr）, central venous pressure （CVP） and serum potassium level were detected both before and after sequential dialyses, and the obtained results were compared between the patients.Results For the 28 cases before and after sequential dialysis, mean LVEDd were （65.00 ± 5.51） mm and （35.00 ±1.42） mm （t=7.16,P〈0.05）, meanSVwere （54.00±2.21） mland （76.00±6.33） ml （t=4.42,P〈 0.05）, mean LVEF were （42.80±3.71）% and （64.90±5.42） % （t=5.91,P〈0.05）, and mean CO （L/min） were （2.93 ± 0.95） L/min and （5.78 ± 1.83） L/min （t =2.3, P 〈 0.05）, respectively.In the 16 patients with ARF, mean BUN were （40.26 ±3.19） mmol/L and （6.15 ± 1.03） mmol/L （t =13.02,P 〈0.05）, mean SCr were （256.00 ± 11.76） μmol/L and （106.00 ± 6.87） μmol/L （t =9.94, P 〈 0.05）, and mean serum potassium were （6.18 ± 0.92） mmol/L and （4.02 ± 0.13） mmol/L （t =3.09,P 〈 0.05） respectively, before and after sequential dialysis.In the 20 patients with elevated CVP, mean CVP were （2.66 ± 0.33） kPa and （1.19 ± 0.14） kPa （t =7.56, P 〈 0.05） respectively, before and after sequential dialysis.There was statistical significance, when comparisons were made between pre-treatment and posttreatment （P〈0.05）.Of the 28 cases, 23 were cured （82.14%）, with only 5 dead cases（17.86%）.Conclusions Sequential dialysis was effective in the treatment of HF and or MOF induced by jellyfish sting.