糖皮质激素与血液灌流治疗重度蜂蜇伤致多器官综合征临床疗效观察

Clinical observation of glucocorticoid combined with hemoperfusion in treating MODS caused by severe bee sting

目的分析糖皮质激素与血液灌流(HP)联合治疗重度蜂蜇伤所致多器官功能障碍综合征(MODS)临床疗效。方法选取2014年6月~2016年3月本院收治的66例重度蜂蛰伤并发MODS患者作为研究对象,将所选患者按照随机数字表法进行分配,分为观察组与对照组,每组各33例。对照组给予常规治疗联合HP治疗,观察组在对照组的基础上加上糖皮质激素联合治疗。回顾性分析两组的临床资料,比较糖皮质激素与HP联合治疗重度蜂蜇伤所致MODS患者的临床疗效及安全性。结果两组患者死亡率比较,差异无统计学意义(P>0.05)。治疗前,两组患者Scr、BUN、ALT、AST、CK-MB、CRP及Hb水平比较,差异无统计学意义(P>0.05)。治疗后第7天,两组患者Scr、BUN、ALT、AST、CK-MB、CRP及Hb水平比较,差异有统计学意义(P<0.05)。两组患者进行少尿、无尿期及多尿期发生率比较,差异无统计学意义(P>0.05);两组患者进行多尿期时间及肾功能恢复时间比较,差异有统计学意义(P<0.05)。结论糖皮质激素与HP联合治疗重度蜂蜇伤所致MODS临床疗效更显著,有利于患者受损器官功能的恢复,缩短治疗时间,明显改善患者预后,值得临床推广。

Objective To investigate the clinic effect of glucocorticoid combined with hemoperfusion in treating MODS caused by severe bee sting. Methods 66 patients with MODS caused by severe bee sting admitted to our hospital from June 2014 to Mareh 2016 were selected and divided into observation group and control group, 33 cases in each group. Control group was given regular treatment and HP. Observation group was given glucocorticoid based on control group. Clinic data of the two groups were retrospectively analyzed. The clinieal efficacy and safety of glucocorticoid com- bined with hemoperfusion （HP） in the treatment of multiple organ dysfunction syndrome （MODS） caused by severe bee stings were compared and analyzed. Results No significant difference was detected between the two groups in the mor- tality rate （P〉0.05）. No significant differences were detected in the levels of Ser, BUN, ALT, AST, CK-MB, CRP and Hb-related biochemical indexes between the two groups before treatment （P〉 0.05）. The levels of Scr, BUN, ALT, AST, CK-MB, CRP and Hb-related biochemical indexes were statistically significant different （P〈0.05）. No significant difference was detected between the two groups in the incidence of oliguria, uremia and polyuria （P〉0. 05）. Significant difference was detected between the two groups in the duration of polyuria and the recovery time of renal func- tion （P〈0.05）. Conclusion The combination of glucocorticoid and hemoperfusion in the treatment of multiple organ dysfunction syndrome （MODS） caused by severe bee stings is more effective, which is beneficial to the recovery of organ function, shorten the treatment time and improve the patients prognosis.