重症蜂蛰伤患者腹膜透析与连续性静--静脉血液滤过治疗的疗效分析  

A retrospective study of peritoneal dialysis and continuous vena- vena hemodialysis / hemofiltration in treatment of severe bee venom intoxication patients

作　　者：王晓明[1] 孙燕[1] 梁衍[1] 高妍婷[1] 冯婷[1] 金刚[1] 鲁艳搏 孙小蕊 李振江[1] 

机构地区：[1]陕西省人民医院肾病内科,西安710068

出　　处：《中国血液净化》2015年第4期219-223,共5页Chinese Journal of Blood Purification

摘　　要：目的比较腹膜透析(PD)和连续性静-静脉血液透析/滤过(CVVH)对于蜂蛰伤合并多器官功能障碍综合征(MODS)的重症蜂蛰伤患者的治疗效果。方法采用病例回顾性调查方法,收集就治于陕西省人民医院肾病内科的30例蜂蛰伤合并MODS的病例资料,其中CVVH组18例,PD组12例。具体包括一般资料,疾病严重程度(APACHEⅡ评分),透析前和透析后血白细胞、血红蛋白、转氨酶、肌酸激酶、肌酐、胆红素,乳酸脱氢酶的变化、患者存活率、透析相关并发症、住院时间、平均每日透析费用。结果 CVVH和PD组患者的年龄、性别构成和疾病严重程度无不同(P>0.05)。2组患者中肾功能恢复及存活者所占比例无显著性差异(P>0.05)。CVVH和PD组在治疗剂量(58.68±12.53L/d vs.11.45±6.62 L/d,P<0.05)治疗时间(7.25±9.65 d vs.13.23±11.75 d,P<0.05)及每日超滤量(3264.3±1421.68 ml/d vs.1747.36±826.14 ml/d,P<0.05)均有显著性差异。PD组住院日较CVVH组明显缩短(25.86±14.62d vs.15.64±15.08,P<0.05),出院时PD组血肌酐显著高于CVVH组。2组随访3月,肾脏存活率KM生存曲线在整体上没有统计学差别P>0.05。CVVH组患者合并透析相关并发症及住院日高于PD组(55%;25.86±14.62 d vs.15%;19.64±15.08 d,P<0.05);CVVH组患者平均每日透析费用为(6020.34±1201.32)元高于PD组的(592.92±138.62)元(P<0.01)。结论 PD与CVVH治疗重症蜂蜇伤的疗效相当,但PD技术更为简单和经济,可作为重症蜂蜇伤的主要治疗方法。Objective To compare the effect of peritoneal dialysis （PD） and continuous vena-vena he- modialysis / hemofiltration （CVVH） on the patients with bee venom-induced multiple organ dysfunction syn- drome （MODS）. Methods We retrospectively reviewed 30 cases with bee venom-induced MODS, among whom 12 patients were treated with PD （PD group） and 18 patients with CVVH （CVVH group）. Clinical data including age, sex, dialysis type, disease severity （APACHE II score）, Hb, WBC, serum Cr, ALT, TBil and CK, dialysis related complications, and dialysis expenses per day were collected. Results There were no dif- ferences in age, sex, disease severity, and serum biochemical changes between the two groups （P〉0.05）, nor in renal recovery rate and mortality between the two groups （P〉0.05）. However, dialysis related complica- tions were found in 55% patients in CVVH group, but was only 15.3% patients in PD group （P〉0.05）. Thera- peutic doses （58.68±12.53 L/d vs. 11.45±6.62 L/d, P〉0.05）, dialysis duration （7.25±9.65 L/d vs. 13.23±11.75 d, P〉0.05）, and daily ultrafiltration volume （3264.3±1421.68 ml/d vs. 1747.36±826.14 ml/d, P〉0.05） were significantly different between CVVH group and PD group. Patients in the two groups were followed up for 3 months. Kaplan-Meier survival curves showed no overall survival difference between the two groups （P〉 0.05）. Dialysis expenses per day were 6020.34± 1201.32 yuan in CVVH patients, higher than 592.92±138.62 yuan in PD patients. Conclusion CVVH and PD had similar effect in treatment of bee venom-induced MODS. PD is simpler and less expenses than CVVH. Therefore, PD should be used as the preferential method for bee venom-induced MODS.

关 键 词：重症蜂蜇伤 腹膜透析 连续性静-静脉血液透析/滤过 

分 类 号：R459.5[医药卫生—治疗学]