血浆置换联合连续性血液净化治疗重度蜂毒致多器官功能障碍综合征  

Plasma exchange combined with continuous blood purification treatment for severe bee venom-induced multiple organ dysfunction syndrome

作　　者：宋雪霞[1] 

机构地区：[1]广西医科大学第四附属医院肾内科,广西柳州545005

出　　处：《中国急救医学》2010年第9期841-843,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的 总结血浆置换（PE）联合连续性血液净化（CBP）治疗重度蜂毒致多器官功能障碍综合征（MODS）的疗效.方法 对18例重度毒蜂蜇伤患者在内科综合治疗基础上,先PE治疗,随后立即进行CBP治疗,治疗前、PE后、CBP结束时检测肝肾功能、心肌酶学、C反应蛋白（CRP）及TNF-α.结果 在治疗过程中血流动力学稳定,PE后转氨酶（ALT、AST）、心肌酶（CPK、CPK-MB）、TNF-α及CRP迅速下降（P〈0.01）,而BUN、Cr下降不明显;CBP治疗后BUN、Cr、ALT、AST、CPK、CPK-MB、TNF-α及CRP呈进行性下降（P〈0.01）,而总胆红素（TBIL）变化不明显;TNF-α、CRP在PE结束时显著下降,随着CBP治疗时间延长呈进行性下降,且APACHEⅡ评分和SOFA评分呈进行性下降（P〈0.01）,无死亡病例.结论 PE联合CBP治疗能减轻重度蜂毒致MODS患者体内的炎症反应,改善肝、肾及心肌功能,显著改善患者预后.Objective To summarize the curative effect of the plasma exchange （ PE ） and continuous blood purification （CBP） for severe bee venom -induced multiple organ dysfunction syndrome （MODS）. Methods 18 cases of severe wasps sting on the basis of medical treatment, accepted PE and CBP treatment in order. Before treatment, after the PE, the end of CBP, liver and kidney function, myocardial enzyme, CRP, TNF-α were examined. Results In the course of treatment, hemodynamic was stable, after PE the ALT, AST, CPK, CPK- MB, TNF-α, CRP decreased rapidly （P 〈 0.01 ）, while BUN, Cr decrease was not obvious ; after CBP treatment BUN, Cr, ALT, AST, CPK, CPK - MB, TNF - α, CRP decreased progressively （ P 〈0. 01）, while the TBIL did not change significantly; TNF - α, CRP at the end of PE decreased significantly, with the CBP treatment extended, decreased progressively, and the APACHE Ⅱ score and SOFA score decreased progressively （P 〈 0. 01 ）. There were no death cases. Conclusion PE and CBP therapy can reduce the venom- induced MODS in the patients with severe inflammatory response in vivo, improve liver, kidney, heart function and significantly improve the prognosis of patients.

关 键 词：血浆置换(PE) 连续性血液净化(CBP) 蜂毒 多器官功能障碍综合征(MODS) 

分 类 号：R59[医药卫生—内科学]