甲泼尼龙冲击联合多种血液净化技术治疗蜂蛰伤致多器官功能衰竭

Methylprednisolone Combined with Multiple Blood Purification Technology for the Treatment of Multiple Organ Failure Caused by Bee Sting Injury

目的探讨大剂量甲泼尼龙冲击基础上联合PE,再串联CRRT、HP、HD多种血液净化技术的应用,治疗毒蜂致多器官功能衰竭的临床疗效。方法回顾性分析65例蜂蛰伤致多器官功能衰竭患者,分为观察组(33例)和对照组(32例)。观察两组治疗前、治疗7d后丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、肌酸激酶(CK)、肌酸激酶同工酶(CKMB)、血红蛋白(HGB)、白细胞总数(WBC)、肌酐(CREA)等水平变化,并观察临床疗效。结果与治疗前相比两组患者在治疗7d后的丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)下降明显,差异有统计学意义(P<O.05);治疗7d后两组间比较上述血生化指标差异有统计学意义(P<0.05)[ALT(P=0.01);TBIL(P=0.03);CK(P=0.000);CK-MB(P=0.001);HGB(P=0.004);CREA(P=0.027)]。组间分析比较显示,观察组与对照组进行比较,治疗7d后的丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)水平下降更为显著,血红蛋白(HGB)下降幅度及血肌酐(CREA)上升幅度较对照组明显减慢,差异有统计学意义(P<O.05)。结论大剂量甲泼尼龙冲击基础上联合PE,再串联CRRT、HP、HD多种血液净化技术的应用,可迅速抑制急性变态反应和炎症反应综合征,阻断其脏器功能损害的病理生理机制,高效清除蜂蛰伤致多器官功能衰竭状态下的毒性物质。特别实用于西部偏远山区,可极大地节约医疗资源,减少费用,更好促进患者身体康复,降低死亡率。在治疗毒蜂蛰伤致多器官功能衰竭综合救治中,值得临床推广应用。

Objective To investigate the clinical curative effeet of high dose of methylprednisolone combined with PE, and the application of multiple blood purification technology like CRRT, HP and HD in the treatment of multiple organ failure- eaused by bee sting injury. Methods 65 eases of patients with multiple organ failureeaused by bee sting injury were retrospeetive- ly analyzed and divided into observation group （33 cases） and control group （ 32 eases）. Changes of alanine amino transferase （ALT） , total bilirubin （TBIL） , ereatine kinase （CK） , ereatine kinase isoenzyme （ CK-MB ） , hemoglobin （ HGB ） , white blood cell count （ WBC）, and ereatinine （CREA） levelsin the 2 groups of patients before treatment and 7 days after the treatment and the clini- eal curative effectwere observed. Results Compared with before treatment, the alanine aminotransferase （ ALT ） , total hilirubin （ TBIL）, creatine kinase （ CK）, and creatine kinase isoenzyme （CK-MB） decreased signifieantly in the 2 groups after treatment for 7 days,and the difference was statistically signifieant（ P 〈 0. 05 ）. After 7 days of treatment, the difference of the above blood bio- chemical indexes between the 2 groups was statistically significant [ ALT （ P = 0. 01 ） ; TBIL （ P = 0. 03 ） ; CK （ P = 0. 000 ） ; CK-MB （P =0. 001 ） ;HGB（P =0. 004） ;CREA（P =0. 027） ]. The analysis of comparison between the two groups showed that compared with the control group, after 7 days of treatment,levels of alanine amino transferase （ALT）, total bilirubin （TBIL）, creatine kinase （CK）, and ereatine kinase（CK-MB） in the observation group decreased significantly, and the decrease of hemoglobin （HGB）and the increase of serum creatinine（CREA） were significantly lower, and the difference was statistically significant（ P 〈 0. 05 ）. Con- dusion High dose of methylprednisolone combined with PE, and the application of multiple blood purification technology like CRRT, HP and HD can rapidly inhibit the aeute allergic reaction and inflammatory reaction syndrome, blockthe pathophysiological mechanism of organ damage, and efficiently remove toxic substances under the state of multiple organ failure caused by bee sting injury. This method is particularly useful in remote mountainous areas in the west, which can greatly save medical resources, reduce costs, better promote the rehabilitation of patients, and reduce mortality. And it is worthy of clinical application in the comprehen- sive treatment of multiple organ failure caused by poisonous bee sting injury.