糖皮质激素联合血液净化治疗蜂蜇伤性多功能障碍综合征患者的临床效果

Clinical Treatment of Glucocorticoid Combined with Blood Purification in the Treatment of Bee sting Multifunctional Disorder Syndrome

目的探讨糖皮质激素联合血液净化治疗蜂蜇伤所致多器官功能障碍综合征的疗效。方法选取高州市人民医院重症医学科2016年1月至2019年4月收治的蜂蜇伤所致多器官功能障碍综合征患者40例作为研究对象,将其随机分为观察组和对照组,各20例。观察组采用常规治疗+早期激素+血液净化治疗,对照组采用常规治疗+早期激素治疗,比较两组患者治疗前后凝血功能变化情况、炎症介质水平以及肝肾功能变化。结果与治疗前比较,两组患者治疗后凝血功能指标(PT、APTT、TT及FIB)、WBC、炎症介质(IL-1、IL-6及TNF-α)以及肝肾功能指标(ALT、AST及Cr)均呈下降趋势,且观察组患者的凝血功能指标(PT、APTT、TT及FIB)、WBC、炎症介质(IL-1、IL-6及TNF-α)以及肝肾功能指标(ALT、AST及Cr)均显著低于对照组(均P<0.05)。两组痊愈、显效、好转、恶化、死亡患者比例,差异均无统计学意义(均P>0.05)。结论蜂蜇伤性多功能障碍综合征患者实施糖皮质激素联合血液净化治疗对改善患者凝血功能、炎症介质水平以及肝肾功能效果显著。

Objective To explore the efficacy of glucocorticoid combined with blood purification in the treatment of multiple organ dysfunction syndrome caused by bee sting.Methods A total of 40 patients with multiple organ dysfunction syndrome caused by bee sting were randomly divided into observation group and control group,with 20 cases in each group,from January 2016 to April 2019 in the Department of Severe Medicine of Gaozhou People’s Hospital.The observation group was treated with routine therapy+early hormone+blood purification therapy,while the control group was treated with routine therapy+early hormone therapy.The changes of coagulation function,inflammatory mediators and liver and kidney function were compared between the 2 groups before and after treatment.Results Compared with those before treatment,the indexes of coagulation function(PT,APTT,TT and FIB),WBC,inflammatory mediators(IL-1,IL-6 and TNF-alpha)and liver and kidney function indicators(ALT,AST and Cr)showed a downward trend after treatment in both groups,and the indexes of coagulation function(PT,APTT,TT and FIB),WBC,inflammatory mediators(IL-1,IL-6 and TNF-α)in the observation group showed a downward trend.Liver and kidney function indexes(ALT,AST and Cr)were significantly lower than those of the control group(P<0.05).There was no significant difference in the proportion of patients recovered,markedly improved,worsened and died between the 2 groups(P>0.05).Conclusion The effects of glucocorticoid combined with blood purification on improving coagulation function,inflammatory mediator level and liver and kidney function in patients with bee sting multifunctional disorder syndrome is remarkable.