两种方案用于蜂蜇伤所致急性肾功能衰竭的疗效分析

A comparative study of the efficacy of CVVH/IHD and HP/IHD for bee stings caused by acute renal failure

目的:比较连续性静脉—静脉血液滤过(CVVH)联合间歇性血液透析(IHD)与血液灌流(HP)联合IHD治疗蜂蜇伤所致急性肾功能衰竭(ARF)的临床疗效。方法:收集2010—2016年雅安市人民医院救治的蜂蜇伤所致ARF患者78例。将患者随机分为两组:CVVH/IHD组(n=40),以CVVH+IHD进行治疗;HP/IHD组(n=38),作为对照组,采用HP+IHD进行治疗。比较两组患者治疗前及治疗后的血肌酐(Scr)、尿素氮(BUN)、β2-微球蛋白(β2-MG)、K^+等的变化情况及清除率,并观察外周血白细胞数、血小板数、红细胞数、血红蛋白浓度、总蛋白、C反应蛋白、电解质(K^+、Cl^-),比较各组的总有效率、少尿期平均持续时间和平均住院时间。结果:两组患者一般临床资料差异无统计学意义(P>0.05)。治疗后两组患者病情均有所改善(P<0.05)。CVVH/IHD组较HP/IHD组的BUN和Scr浓度下降更明显,尿素氮、肌酐、β2-微球蛋白清除率更高(P<0.05),而β2-MG、K^+和超敏C反应蛋白(hs-CRP)浓度两组差异无统计学意义(P>0.05)。HP/IHD组总有效率低于CVVH/IHD组,少尿期时间和住院时间均高于CVVH/IHD组(P<0.05)。HP/IHD组不良事件发生率为2.63%(1/38),CVVH/IHD组不良事件发生率为2.50%(1/40),两者差异无统计学意义(P>0.05)。结论:CVVH联合IHD可有效地清除蜂蛰伤致ARF患者体内毒性物质,对肾脏功能改善临床疗效显著,可提高患者的治愈率,无严重不良反应。

Objective：To comparison of continuous veno-venous hemofiltration（CVVH） combined with intermittent hemodialysis（IHD） and hemoperfusion in the treatment of acute renal failure（ARF） caused by bee stings.Methods：Seventy eight ARF patients caused by bee stings collected from 2010 to 2016 in our hospital.They were randomly divided into two groups.CVVH/IHD group（n=40） was treated with CVVH ＋ IHD.HP/IHD group（n=38） was treated with HP ＋ IHD.Scr,BUN,β2-microglobulin（β2-MG） and so on in the two groups were observed before and after treatment and the number of peripheral white blood cells were observed.Platelet count,erythrocyte count,hemoglobin concentration,total protein,C-reactive protein,and electrolyte（K^＋,Cl^-）were also studied.The total effective rate,mean duration of oliguria and average hospital stay were compared.Results：There was no significant difference in clinical data between the two groups（P〉0.05）.After treatment,all the patients were improved（P〈0.05）.The levels of BUN and Scr in CVVH/IHD group were significantly higher than those in HP/IHD group（P〈0.05）,while the changes of β2-MG,K^＋and hs-CRP were not significantly different between the two groups（P〉0.05）.The total effective rate of HP/IHD group was lower than that of CVVH ＋ IHD group,and the duration of urinary catheterization and hospital stay were higher than those of CVVH ＋ IHD group（P〈0.05）.The incidence of adverse events in the HP/IHD group was 2.63%（1/38） and the incidence of adverse events in the CVVH/IHD group was 2.50%（1/40）.Conclusion：CVVH combined with IHD can effectively remove the toxic substances in the body,significantly improve the clinical efficacy of renal function,increase the patient＇s curative rate without serious adverse reactions.