血液灌流联合连续性血液透析治疗马蜂蜇伤并发多器官功能障碍综合征疗效观察

Treatment of wasp sting complicated with multiple organ dysfunction syndrome by hemoperfusion and continuous hemodialysis

目的探讨血液灌流联合连续性血液透析治疗马蜂蜇伤并发多器官功能障碍综合征(MODS)的临床疗效。方法收集2015年1月至2018年1月就诊于本院的50例马蜂蛰伤并发MODS的患者,将患者随机分为对照组和观察组(每组25例)。对照组实施血液灌流联合间歇性血液透析治疗,观察组实施血液灌流联合连续性血液透析治疗。比较两组的临床疗效、血液透析治疗时间、机械通气时间、重症监护室(ICU)治疗时间和住院时间以及治疗前后的急性生理与慢性健康评分(APACHEⅡ)、血清C反应蛋白(CRP)、白细胞介素6(IL-6)、降钙素原(PCT)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、血尿素氮(BUN)、血肌酐(Ser)、左室舒张末内径(LVEDd)、左室射血分数(LVEF)和不良反应。结果两组患者均无死亡病例。与对照组相比,观察组的总有效率较高(P<0.05)。与对照组相比,观察组的血液透析治疗时间、机械通气时间、ICU治疗时间和住院时间均明显减少(P<0.05)。治疗前,两组APACHEI评分、CRP、IL-6、PCT、APTT、PT、TT、INR、ALT、AST、BUN、Ser、LVEDd和LVEF比较,差异无统计学意义(P>0.05)。治疗后,与对照组相比,观察组APACHEⅡ评分、CRP、IL-6、PCT、ALT、AST、BUN、Ser和LVEDd明显降低(P<0.05),APTT、PT、TT、INR和LVEF均有不同程度地增加(P<0.05),不良反应明显降低(P<0.05)。结论在马蜂蛰伤并发MODS患者治疗中,应用血液灌流联合连续性血液透析方案,可有效改善患者病情,其机制与改善炎症因子凝血、肝肾和心功能相关。

Objective To study the treatment of wasp sting complicated with multiple organ dysfunction syndrome(MODS)by different blood purification methods.Methods From January 2015 to January 2018,50 cases wasp stinging injurypatients with MODS were selected and randomly divided into two groups(25 cases per group).The control group were treated with hemoperfusion and intermittent hemodialysis and the observation group were treated with hemoperfusion and continuous hemodialysis.The clinical efficacy,mechanical ventilation time,intensive care unit(ICU)treatment time and hospitalization time,acute physiology and chronic health evaluationⅡ(APACHEⅡ)between two groups were compared.The serum C-reactive protein(CRP),interleukin-6(IL-6),procalcitonin(PCT),aspartate aminotransferase(AST),alanine aminotrans(ALT),blood urea nitrogen(BUN),serum creatinine(Scr),left ventricular enddiastolic dimension(LVEDd)and left ventricular ejection fraction(LVEF)and side effect before and after treatment were compared.Results There were no deaths in two groups.Compared with the control group,the total effective rate of the observation group was higher than that of the control group(P<0.05).Compared with the control group,the blood purification treatment time,the mechanical ventilation time,ICU treatment time and hospitalization time of the observation group had significantly reduced(P<0.05).Before treatment,there had no significant difference in APACHEII,CRP,IL-6,PCT,APTT,PT,TT,INR,ALT,AST,BUN,Scr,LVEDd and LVEF between two groups(P>0.05).After treatment,compared with the control group,the APACHEII,CRP,IL-6,PCT,ALT,AST,BUN,Ser and LVEDd had significantly decreased(P<0.05),and APTT,PT,TT,INR and LVEF had increased in the observation group(P<0.05).Compared with the control group,the side effect of the observation group had decreased(P<0.05).Conclusions In the treatment of patients with wasp stinging injury complicated with MODS,the application of hemoperfusion and continuous hemodialysis can effectively improve the patient’s condition by improve inflammation,coagulation,liver,kidney and heart function.