血液灌流联合甲泼尼龙片对重度蜂蜇伤致MODS患者肾功能及预后的影响  

Effects of Hemoperfusion Combined With Methylprednisolone Tablets on Renal Function and Prognosis of Patients With MODS Caused By Severe Bee Stings

作　　者：付向阳[1] Fu Xiangyang(Affiliated Hospital of Xinyang Vocational and Technical College,Xinyang 464000,China)

机构地区：[1]信阳职业技术学院附属医院,河南信阳464000

出　　处：《哈尔滨医药》2022年第1期25-27,共3页Harbin Medical Journal

摘　　要：目的探讨血液灌流(HP)联合甲泼尼龙片治疗重度蜂蛰伤致多器官功能障碍综合征(MODS)的疗效以及对患者肾功能、预后的影响。方法选取70例蜂蛰伤致MODS患者,随机数字表法将其分为观察组和对照组,各35例。对照组接受常规治疗+甲泼尼龙片治疗,观察组在对照组的基础上加用HP治疗。均连续治疗7d。比较两组的住院时间、急性生理与慢性健康状态评估Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA)、病死率,并测定治疗前后的肾功能、凝血功能、心肌损伤标志物水平。结果两组治疗后尿素氮(BUN)、血肌酐(Scr)、血尿酸(Ua)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fbg)、肿瘤坏死因子α(TNF-α)、白细胞介素1(IL-1)、白细胞介素6(IL-6)、白细胞介素8(Il-8)水平比同组治疗前均明显降低,且观察组治疗后的BUN、Scr、Ua、PT、APTT、TT、Fbg、TNF-a、IL-1、IL-6、IL-8水平均较对照组治疗后显著低(P<0.05);观察组的住院时间、APACHEⅡ评分、SOFA评分以及病死率均显著低于对照组,差异具有统计学意义(P<0.05)。结论蜂蛰伤致MODS患者及时采用HP联合甲泼尼龙片治疗可有效地改善患者的肾功能和凝血功能,降低全身炎症反应,促进重要器官微循环,改善患者预后,降低死亡率。Objective To investigate the curative effect of hemoperfusion(HP)combined with methylprednisolone tablets in the treatment of multiple organ dysfunction syndrome(MODS)caused by severe bee stings and the influence on renal function and prognosis.Methods Seventy patients with MODS caused by bee stings who were admitted and treated in the hospital were enrolled and divided into observation group and control group by random number table method,35 cases in each group.The control group was given conventional treatment and methylprednisolone tablets,and the observation group was treated with HP on the basis of the treatment for control group.All subjects were treated for 7 days.The hospital stay,acute physiological and chronic health evaluationⅡ(APACHEⅡ)scores,sequential organ failure assessment(SOFA)scores and case fatality rate were compared between the two groups.Renal function,coagulation function and levels of myocardial injury markers were measured before and after treatment.Results After treatment,urea nitrogen(BUN),serum creatinine(Scr),blood uric acid(Ua),prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(Fbg),tumor necrosis factor(TNF-a),interleukin 1(IL-1),interleukin 6(IL-6)and interleukin 8(Il-8)levels in the two groups were significantly lower than those in the same group before treatment,and the above-mentioned indexes in the observation group were significantly lower than those in the control group after treatment(P<0.05).The hospital stay,APACHE II score,SOFA score and case fatality rate of the observation group were significantly shorter/lower than those of the control group(P<0.05).Conclusion HP combined with methylprednisolone tablets for treating MODS caused by bee stings can effectively improve the patient’s renal and coagulation function,reduce systemic inflammatory response,promote microcirculation of vital organs,improve the prognosis,and reduce mortality.

关 键 词：蜂蛰伤 多器官功能障碍综合征 血液灌流 甲泼尼龙肾功能 预后 

分 类 号：R457.2[医药卫生—治疗学]