不同剂量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研究  

Effectiveness of Different Dosages of Glucocorticoid Combined with Blood Purification in Treating Multiple Organ Dysfunction Syndrome Following Bee Sting

作　　者：刘雷[1] 李良志[1] 何先红[1] 汤跃武[1] 史继红[1] 吴泽成[1] 刘春秋[1] 佘青[1] 

机构地区：[1]重庆三峡中心医院肾内科,重庆市404000

出　　处：《中国全科医学》2011年第11期1205-1207,1210,共4页Chinese General Practice

摘　　要：目的比较不同剂量的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(MODS)的临床疗效。方法回顾性分析我院2004年1月—2010年2月收治的81例蜂蜇伤患者,其中57例(70.37%)发生MODS。57例MODS患者均采用血液净化(血液灌流/血液透析,HP/HD)治疗及激素治疗,共分为以下两组:(1)HP/HD+甲泼尼龙冲击治疗组(HMP组),共26例;(2)HP/HD+常规大剂量甲泼尼龙组(HMC组),共31例。HMP组采用甲泼尼龙0.5 g或1.0 g,1次/d,连续3 d冲击治疗后改为甲泼尼龙40～80 mg/d;HMC组常规应用大剂量激素,甲泼尼龙80～160 mg/d。两组均采用HP/HD,1次/d,连续3次后改为HD,每周3次治疗。结果 HMP组26例患者中21例(80.77%)好转出院,4例死亡,1例患者24 h后自动出院后死亡。HMC组31例患者中22例(70.97%)好转出院,7例死亡,2例患者入院后48 h内自动出院后死亡;两组患者的生存率间差异无统计学意义(χ2=0.733,P>0.05)。入院第1天两组患者的血肌酐(SCr)、总胆红素(TB iL)、丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、白细胞计数(WBC)及血红蛋白(Hb)间差异均无统计学意义(P>0.05)。入院第7天两组患者的TB iL、ALT、AST、LDH、CK、CK-MB、WBC及Hb间差异均有统计学意义(P<0.05)。结论甲泼尼龙冲击治疗与常规大剂量激素相比,可能有利于加快患者受损器官功能的恢复,缩短住院时间,但能否提高患者的生存率还有待进一步临床研究证实。Objective To investigate the effectiveness of different dosage of glucocorticoid combined with blood purification in treating multiple organ dysfunction syndrome following bee sting.Methods The clinical data of 81 patients with bee sting injury between January 2004 and February 2010 were retrospectively analyzed,among whom 57 patients（70.37%） suffered from multiple organs dysfunctional syndrome（MODS）.These 57 cases were administered with glucocorticoid and blood purification（HP/HD）,and were divided into two groups based on the dose of methylprednisolone：HMP group：HP/HD＋ methylprednisolone pulse therapy（n=26）;and HP/HD＋ conventional high-dose methylprednisolone therapy（HMC group,n=31）.In the HMP group,methylprednisolone（0.5 g or 1.0 g,given every day for 3 times） was given,followed by conventional methylprednisolone（40～80 mg/d） therapy.In the HMC group,methylprednisolone（80～160 mg/d） was given.Both two groups were given HP/HD once daily for three days,and then hemodialysis（HD）was performed three times per week.Results In the HMP group,21 patients（80.77%） were smoothly discharged after their conditions had been improved,4 patients（5%） died in hospital,and 1 patients died after discharge.In the HMC group,22 patients（70.97%） were smoothly discharged after their conditions had been improved,7 patients died in hospital,and 2 patients died 48 hours after discharge.The survival rate（80.77%） of the HMP group was not significantly higher than that of the HMC group（P0.05）.The serum creatinine（SCr）,bilirubin total（TBIL）,alanine aminotransferase（ALT）,lactate dehydrogenase（LDH）,creatine kinase（CK）,MB isoenzyme of creatine kinase（CK-MB）,white blood cell（WBC）,and hemoglobin（HB） were not significantly different between HMP group and HMC group on the first day after admission（all P0.05） but were showed significant differences on the 7th day after admission（all P0.05）.The days required for entering diuresis stage in the HMC g

关 键 词：蜂蜇伤 多器官功能障碍综合征 血液灌流 血液透析 糖皮质激素 

分 类 号：R646[医药卫生—外科学]