重症蜂蜇伤患者不同时机血液净化干预的效果及价值分析

Effect and Value Analysis of Blood Purification Intervention in Different Times for Patients with Severe Bee Sting

目的观察蜂蜇伤患者采用多器官/系统损害程度评分为早期时行血液净化干预的效果。方法选取内江市第二人民医院肾内科2011年1月1日—2013年8月31日收治重症蜂蜇伤患者82例,根据血液净化时机不同分为观察组与对照组,每组41例,两组均行普通血液透析(HD)+血液灌流(HP)血液净化模式,对照组当RIFLE分期达I期进行,观察组当多器官/系统损害程度评分≥5分时进行,观察两组生化指标、血液净化后12 h和48 h多器官/系统损害程度评分、严重不良事件发生及住院时间和住院费用等。结果两组治疗后生化指标水平较治疗前均明显降低(P<0.01),均恢复至正常水平;观察组蜇伤至血液净化时间明显短于对照组(P<0.01);观察组蜇伤后48 h评分明显低于对照组(P<0.01),且下降率明显高于对照组(P<0.01);两组不良事件发生率比较差异无统计学意义(P>0.05);观察组住院时间、住院费用均明显低于对照组(P<0.01)。结论在多器官/系统损害程度评分法判定重症蜂蜇伤患者早期时行血液净化效果明显优于RIFLE分期为Ⅰ期时,前者可快速清除毒素,避免造成不可逆性损伤,减轻痛苦,促进早期康复,减少医疗费用。

Objective To observe effects of multiple organ/system damage degree score for patients with severe bee sting undergoing blood purification intervention in early period. Methods A total of 82 patients with severe bee sting admitted during 1^stJanuary 2011 and 31 stAugust 2013 were divided into observation group（ n = 41） and control group（ n= 41） according to different time of blood purification. All patients were treated with hemodialysis（ HD） ＋ hemoperfusion（ HP） blood purification model,and control group began when RIFLE staging reached to grade I,while observation group began when multiple organ / system damage was equal and more than 5 score. Biochemical indicators,multiple organ / system damage scores 12 h and 48 h after blood purification,incidence rate of serious adverse events,hospitalization time and cost were observed in two groups. Results After treatment,levels of biochemical indicators were significantly lower than those before treatment in two groups（ P〈0. 01）,and all levels were restored to normal. Compared with those in control group,in observation group,time from sting to blood purification was significantly shorter（ P〈0. 01）; score in48 h after sting was significantly lower（ P〈0. 01）,and the reduction rate was significantly higher（ P〈0. 01）. There was no significant difference in incidence rate of adverse events between two groups（ P〉0. 05）. In observation group,values of hospitalization time and cost were significantly lower than those in control group（ P〈0. 01）. Conclusion Multiple organ / system damage degree score in evaluation of effect of blood purification for patients with severe bee sting in early period is obviously better than that in patients with grade I RIFLE stage,and it can quickly remove toxin,avoid causing irreversible damage,decrease pain,promote early rehabilitation and reduce medical expenses of patients.