蜂蜇伤发病机制和临床治疗的研究现状

Research Progress of Pathogenesis and Clinical Treatment in Patients with Wasp Stings

蜂蜇伤是急诊科医生经常遇到的疾病,大量蜂蜇伤会引起严重的临床反应,如果处理不当,会出现过敏性休克、急性喉头水肿、急性肾损伤、MODS等严重威胁生命的临床症状。过敏反应和直接毒性是其主要损伤机制。毒液免疫治疗是一种有效的治疗蜂蜇伤的方法,其安全性高,疗效好,可以明显减轻蜂蜇伤的毒性反应,降低蜂蜇伤的住院率、病死率,但我国尚未开展、普及。血液灌流和血液透析是目前公认的治疗急性肾损伤和MODS的最有效疗法,其可以滤过血液中的各种毒性分子,对保护肾脏和其他各重要脏器功能,降低病死率和住院天数等有重要意义。本文主要就蜂蜇伤的发病机制和临床治疗中的血液净化技术以及毒液免疫治疗研究现状综述如下,以期提高急诊科医生对蜂蜇伤的诊治水平。

Multipled wasp stings can cause serious toxic reactions.If handled improperly,there will be anaphylactic shock,acute laryngeal edema,acute kidney injury,MODS and other serious life-threatening clinical symptoms.Anaphylaxis and direct toxicity are the main mechanisms of injury.VIT(venom immunotherapy)is an effective method to treat wasp sting injury with high safety and good effect,which can significantly reduce the toxic reaction of sting injury and reduce the hospitalization rate and mortality.However,it has not been carried out and popularized in our country.Hemoperfusion and hemodialysis are currently recognized as the most effective therapies for acute kidney injury and MODS.They can filter various toxic molecules in the blood and have important significance in protecting kidney and other important organ functions,reducing mortality and hospitalization days.This paper mainly reviews the pathogenesis of wasp stings,blood purification technology in clinical treatment and the status quo of VIT in order to improve the level of diagnosis and treatment of wasp stings by emergency doctors.