中西医结合治疗蜂蜇伤研究进展

Research Progress of Integrated Traditional Chinese and Western Medicine in the Treatment of Bee Sting

蜂蜇伤主要通过直接毒性作用和过敏反应致病,轻者局部红肿疼痛及瘙痒,重症可致心、肝、肾功损害和凝血异常,危重症早期主要为过敏性休克,后期为多器官功能障碍综合征。外周血中性粒细胞计数与淋巴细胞计数比值、肌酸激酶、超敏肌钙蛋白I、丙氨酸转氨酶、活化部分凝血酶原时间延长、蜇伤蜂种、总胆红素、肉眼血尿、白细胞高于20×10~9/L、年龄≥60岁、pH值≤7.30、肌酐>111.0 mmol/L系独立危险因素,而血清白蛋白>35 g/L时则为保护因素;IL-33和血清高迁移率族蛋白B1在急性肾损伤的发生过程中起重要作用,血淀粉酶和肉眼血红蛋白尿可作为判断蜂蛰伤严重程度的指标。血液净化治疗蜂蛰伤重症是临床确切有效的方法,联合中医药清热凉血解毒、祛风止痒止痛,能更快改善症状,提高疗效。

Bee sting mainly caused diseases by allergic reactions and direct toxic effects,the mild cases experience local redness,swelling,pain and pruritus,the severe cases can cause damage to the heart,liver and kidney,abnormal coagulation,its manifestation in early stage of critical illness is mainly anaphylactic shock,and in the later stage is multiple organ dysfunction syndrome.Studies have shown that the ratio of peripheral blood neutrophil count to lymphocyte count,creatine kinase,high-sensitivity troponin I,alanine aminotransferase,prolonged activated partial prothrombin time,sting bee species,total bilirubin,gross hematuria,white blood cell>20×109/L,age≥60 years,pH≤7.30,creatinine>111.0 mmol/L were independent risk factors,while serum albumin>35 g/L was a protective factor.IL-33 and high mobility group protein B1 play an important role in the development of acute kidney injury.Blood amylase and gross hemoglobinuria can be used as indicators to judge the severity of bee sting.The blood purification is effective and accurate methods to treat severe bee sting.It combined with traditional Chinese medicine to clear heat,cool blood,dispel wind and relieve itching and pain can improve symptoms faster and results in better curative effect.