群蜂蜇伤致多器官功能衰竭22例临床分析

Clinical analysis of 22 cases with massive wasp sting accompanied by multiple organ failure

目的提高群蜂蜇伤致多器官功能衰竭的诊断和治疗水平。方法回顾性分析我院2014年收治的22例重症蜂蜇伤的临床资料,初步探讨其临床表现、诊断及治疗方案。结果 22例群蜂蜇伤致多器官功能衰竭患者主要累及脏器为心脏(22/22,100%)、造血器官(21/22,95.5%)、肝脏(20/22,90.9%)、肾脏(12/22,54.5%)。其中4例出现过敏性休克。蜂蜇伤后出现心肌酶谱异常(22/22,100%)、血象升高且以中性粒细胞为主(21/22,95.5%)、APTT升高(21/22,95.5%)、应激性血糖升高(15/22,68.2%)等。给予局部和全身综合治疗后6例痊愈,13例好转,3例死亡。结论群蜂蜇伤最易出现心、血液、肝、肾等重要组织器官的损伤,甚至出现过敏性休克,及时就诊,给予局部处理、激素治疗、抗感染,必要时早期行血液净化治疗等综合治疗有助于提高疗效,降低死亡率。

Objectives To improve the group of the diagnosis and treatments of severe wasp sting to multiple organ failure.Methods By retrospectively studied the clinical data of 22 cases of group of wasp sting to multiple organ failure which treated in our hospital in 2014,preliminary discussion on the clinical manifestations,diagnosis and treatment. Results Mainly involving organs of 22 cases of patients with massive wasp stung to multiple organ failure： heart（ 22 /22,100%） 、hematopoietic organ（ 21 /22,95. 5%） 、liver（ 20 /22,90. 9%） 、kidney（ 12 /22,54. 5%）. Among them,4 cases of anaphylactic shock. After severe wasp sting,abnormal myocardial enzyme spectum（ 22 /22,100%） 、increased blutbild and mainly neutrophil（ 21 /22,90. 9%） 、elevated activated partial thromboplastin time（ 21 /22,90. 9%） 、stressed hyperglycemia（ 15 /22,68. 2%） and so on. after local and systemic comprehensive treatment,6 cases recovered,13 cases improved and 3 cases died. Conclusions It is most likely to appear the damage of heart、blood、liver、kidney and other important organs after massive wasp sting,even anaphylactic shock. Comprehensive treatment such as in time to see a doctor,to give local processing、hormonal therapy、anti-infection,early line of blood purification treatment when necessary to improve curative effect and depress death rate.