糖皮质激素联合血液灌流对重度蜂蜇伤所致MODS患者受损器官功能恢复的影响及安全性

The Effect and Safety of Glucocorticoid Combined with Hemoperfusion on the Functional Recovery of Damaged Organs in MODS Patients Caused by Severe Bee Stings

目的对重度蜂蜇伤所致多器官功能障碍综合征(MODS)患者受损器官患者开展糖皮质激素联合血液灌流的价值及作用进行探析。方法随机选取2020年4月-2021年12月收治的符合重度蜂蜇伤所致MODS的患者40例。以随机数字表法分组,对照组20例,进行常规治疗,观察组20例,在对照组基础上增加糖皮质激素联合血液灌流。完成干预后,对比组间炎症因子、肝肾功能、肾功能恢复时间、住院时间及并发症。结果两组治疗前C反应蛋白(CRP)、白细胞介素-6(IL-6)差异无统计学意义(P>0.05),治疗后观察组CRP、IL-6依次为(18.20±9.21)mg/L、(26.34±6.81)pg/mL,均低于对照组的(27.11±10.10)mg/L、(37.26±7.25)pg/mL,差异有统计学意义(t=2.915、4.910,P<0.05)。治疗后,与对照组相比,观察组尿素氮(BUN)(9.42±2.15)mmol/L、肌肝(Cr)(134.73±21.36)μmol/L更低,两组比较差异有统计学意义(t=2.959、4.077,P<0.05),观察组肾功能恢复时间、住院时间依次为(28.02±6.21)、(13.56±3.22)d,均短于对照组的(36.91±5.81)、(29.20±6.51)d,差异有统计学意义(t=4.675、9.630,P<0.05)。观察组并发症发生率为0%(0/20),低于对照组30%(6/20),差异有统计学意义(χ^(2)=4.902,P<0.05)。治疗后两组DBIL水平均有降低,但观察组直接胆红素(DBIL)下降水平明显优于对照组;治疗后两组谷丙转氨酶(ALT)水平均上升至峰值,且观察组明显高于对照组,差异有统计学意义(P<0.05)。结论糖皮质激素联合血液灌流对重度蜂蜇伤所致MODS患者进行治疗,可促进患者器官功能恢复,对患者肾功能、炎症反应改善有积极意义,安全性高。

Objective The value and effect of glucocorticoid combined with hemoperfusion in patients with damaged organs in patients with multiple organ dysfunction syndrome(MODS)caused by severe bee stings were explored.Methods From April 2020 to December 2021,40 patients with MODS caused by severe bee sting were randomly selected.20 cases in the control group were treated with routine treatment,and 20 cases in the observation group were treated with glucocorticoid combined with hemoperfusion on the basis of the control group.After completing the intervention,the inflammatory factors,liver and renal function,renal function recovery time,hospitalization time and complications were compared between the groups.Results There was no statistically significant difference in C reactive protein(CRP)and inter leukin-6(IL-6)in the two groups before treatment(P>0.05).After treatment,CRP and IL-6 in the observation group were(18.20±9.21)mg/L and(26.34±6.81)pg/mL,respectively,lower than those in the control group(27.11±10.10)mg/L and(37.26±7.25)pg/mL,and the difference was statistically significant(t=2.915,4.910,P<0.05).After treatment,urea nitrogen(BUN)(9.42±2.15)mmol/L and creatinine Cr(134.73±21.36)μmol/L in observation group were lower than those in control group,there was statistically significant difference between the two groups(t=2.959,4.077,P<0.05).The recovery time of renal function and hospital stay in the observation group were(28.02±6.21)d and(13.56±3.22)d,respectively,which were shorter than those in the control group(36.91±5.81)d and(29.20±6.51)d,and the difference was statistically significant(t=4.675,9.630,P<0.05).The incidence of complications in the observation group was 0%(0/20),lower than that in the control group 30%(6/20),and the difference was statistically significant(χ^(2)=4.902,P<0.05).After treatment,direct bilirubin(DBIL)levels in both groups decreased,but DBIL levels in the observation group were significantly better than those in the control group.alanine amino transferase(ALT)levels in both groups increased to the peak value after treatment,the observation group was significantly higher than the control group,and the difference was statistically significant(P<0.05).Conclusion Combining glucocorticoids and hemoperfusion to treat patients with MODS caused by severe bee stings can promote the recovery of the patients'organ function,have positive significance for the improvement of patients'renal function and inflammation,and have high safety.