黄蜂蜇伤患者发生多器官功能障碍综合征的危险因素分析  

Risk factors analysis of multiple organ dysfunction syndrome in patients with wasp stings

作　　者：马万宇 高建军 甘正辉 谢鹏 Ma Wanyu;Gao Jianjun;Gan Zhenghui;Xie Peng(Department of Emergency,The First People's Hospital of Zunyi(The Third Affiliated Hospital of Zunyi Medical University),Zunyi 563000,Guizhou,China;Department of Critical Care Medicine,The First People's Hospital of Zunyi(The Third Affiliated Hospital of Zunyi Medical University),Zunyi 563000,Guizhou,China)

机构地区：[1]遵义市第一人民医院(遵义医科大学第三附属医院)急诊科,贵州遵义563000 [2]遵义市第一人民医院(遵义医科大学第三附属医院)重症医学科,贵州遵义563000

出　　处：《中国中西医结合急救杂志》2022年第6期690-694,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家自然科学基金(82060359);贵州省科技计划项目(2021-5648)

摘　　要：目的分析黄蜂蜇伤患者发生多器官功能障碍综合征(MODS)的危险因素及其临床意义。方法选择2014年5月至2021年4月入住遵义市第一人民医院急诊科和重症医学科收治的195例黄蜂蜇伤患者作为研究对象。收集患者的性别、年龄、住院时间、全身蜂蜇伤口数、血常规、血生化、凝血功能等资料。根据是否并发MODS将患者分为MODS组和非MODS组。比较两组上述指标的差异;采用Logistic回归分析法分析黄蜂蜇伤患者发生MODS的独立危险因素;并绘制发生MODS患者的受试者工作特征曲线(ROC曲线),评估各指标对患者发生MODS的预测价值。结果共收集195例黄蜂蜇伤患者,41例发生MODS,占21.03%,14例死亡,病死率为7.18%;全身蜂蜇伤口数在11~20处占比最高,为43.59%。黄蜂蜇伤至器官损伤中,急性肾损伤(AKI)发生率最高,为35.38%。与非MODS组比较,MODS组全身蜂蜇伤口数更多〔处:47(35,93)比17(12,25)〕,天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、总胆红素(TBil)、血尿素氮(BUN)、血肌酐(SCr)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、中性粒细胞与淋巴细胞比值(NLR)明显升高〔AST(U/L):683.0(123.5,2935.0)比37.5(24.2,67.6),ALT(U/L):232.0(91.5,1007.0)比25.8(19.3,52.4),TBil(μmol/L):22.7(16.4,81.7)比15.6(10.5,22.9),BUN(mmol/L):12.4(7.6,18.3)比5.4(4.1,7.6),SCr(μmol/L):193.0(85.0,310.5)比69.0(56.1,81.9),CK(kU/L):7.79(1.38,19.74)比0.21(0.11,0.73),CK-MB(U/L):215.0(54.5,450.7)比19.0(14.9,31.8),PT(s):13.9(11.2,16.3)比11.6(10.5,12.9),APTT(s):57.8(31.0,120.0)比27.0(22.0,34.7),NLR(%):25.8(11.6,39.6)比9.8(5.0,14.8),均P<0.05〕。Logistic回归分析显示:蜂蜇伤口数、CK、AST、ALT、BUN、NLR是黄蜂蜇伤患者并发MODS的独立危险因素〔优势比(OR)值和95%可信区间(95%CI)分别为1.078(1.038~1.119),1.000(1.000~1.001),0.996(0.943~0.989),1.008(1.001~1.015),1.011(1.001~1.021),1.421(1.041~1.940),1.046(1.005~1.089),�Objective To analyze the risk factors and clinical significance of multiple organ dysfunction syndrome(MODS)in wasp sting patients.Methods The wasp sting patients admitted to the department of emergency and department of critical care medicine of the First People's Hospital of Zunyi from May 2014 to April 2021 were selected as research objects.The data of patient's gender,age,hospital stays,the number of wasp stings,blood routine,blood biochemical indexes,and coagulation function were collected.Patients were divided into the MODS group and non-MODS(NMODS)group according to whether multiple organ injuries occurred.The differences in various indexes between the two groups were compared.Logistic regression was used to analyze the independent risk factors for MODS in patients with wasp stings,and the receiver operator characteristic curve(ROC curve)of patients with MODS was drawn to evaluate the predictive value of each indicator for patients with MODS.Results Among 195 patients with wasp stings,41(21.03%)cases had MODS,and 14 cases died,accounting for 7.18%.The number of wasp stings at 11-20 points accounted for the highest proportion,accounting for 43.59%.The incidence of acute kidney injury(AKI)was the highest among organ injuries in wasp stings patients,accounting for 35.38%.Compared with the NMODS group,the MODS group had more wasp stings[points:47(35,93)vs.17(12,25)],aspartate aminotransferase(AST),alanine aminotransferase(ALT),total bilirubin(TBil),blood urea nitrogen(BUN),serum creatinine(SCr),creatine kinase(CK),MB isoenzymes of creatine kinase(CK-MB),prothrombin time(PT),activated partial thromboplastin time(APTT),neutrophil to lymphocyte ratio(NLR)were significantly increased[AST(U/L):683.0(123.5,2935.0)vs.37.5(24.2,67.6),ALT(U/L):232.0(91.5,1007.0)vs.25.8(19.3,52.4),TBil(μmol/L):22.70(16.4,81.7)vs.15.6(10.5,22.9),BUN(mmol/L):12.4(7.6,18.3)vs.5.4(4.1,7.6),SCr(μmol/L):193.0(85.0,310.5)vs.69.0(56.1,81.9),CK(kU/L):7.79(1.38,19.74)vs.0.21(0.11,0.73),CK-MB(U/L):215.0(54.5,450.7)vs.19.0(14.9,31.8),PT(s):13.9(1

关 键 词：黄蜂蜇伤 多器官功能障碍综合征 危险因素 预测价值 

分 类 号：R73[医药卫生—肿瘤]