黄蜂蜇伤死亡56例临床分析  

Clinical analysis of 56 cases of wasp sting

作　　者：国富建 刘思佳 李沙沙 杨翠 李兴屿 张天喜 Guo Fujian;Liu Sijia;Li Shasha;Yang Cui;Li Xingyu;Zhang Tianxi(Department of Emergency,Affiliated Hospital of Zunyi Medical University,Zunyi Guizhou 563099,China;Department of Emergency,Chengdu Second People's Hospital,Chengdu Sichuan 610000,China)

机构地区：[1]遵义医科大学附属医院急诊科,贵州遵义563099 [2]成都市第二人民医院急诊科,四川成都610000

出　　处：《遵义医科大学学报》2022年第6期766-770,共5页Journal of Zunyi Medical University

基　　金：贵州省卫健委科学技术基金资助项目(NO:gzwkj2021-008);遵义医科大学研究生教育创新计划项目(NO:YZK62)。

摘　　要：目的 探索黔北地区危重黄蜂蜇伤致死的临床特点、治疗手段、相关并发症及主要死亡原因。方法 本研究调查2011年6月至2018年11月期间遵义医科大学附属医院住院治疗的危重黄蜂蜇伤患者,收集患者的一般资料、实验室检测指标、血液净化治疗、并发症、预后,结合相关资料分析。结果 共收集黄蜂蜇伤致死亡患者56例,占总就诊1 987例患者的2.82%。其中男31例,女25例,平均年龄(50.8±17.9)岁。病例分布在夏秋季节,以9、10月最多,头颈部和躯干裸露部位蜇伤多见,主要引起肝、肾功能损害,凝血功能异常以及横纹肌溶解。38例患者进行血液净化治疗,其中血液灌流治疗(Hemoperfusion,HP) 3例,连续性肾脏替代治疗(Continuous renal replacement therapy,CRRT)8例,HP+CRRT治疗17例,HP+CRRT+血浆置换(Plasma exchange,PE)治疗10例,12例患者未行血液净化治疗。死亡患者中6例患者在急诊抢救室即行心肺复苏无好转死亡,50例患者入院后病情加重死亡。死亡时间观察,就诊后24h内死亡26例(46.6%),24~72 h 2例(3.4%),72 h后死亡28例(50%)。10例患者并发致死性出血,其中脑出血5例,消化道大出血2例,脑出血合并消化道大出血2例,气道出血1例。结论 贵州北部黄蜂蜇伤临床常见,严重威胁人民生命健康。危重黄蜂蜇伤患者早期死亡率高,与重度休克相关,后期死亡原因为并发多器官功能衰竭(Multiple organ failure,MOF)以及致死性出血。血液净化是治疗危重黄蜂蜇伤的重要手段,但治疗过程中有增加凝血功能异常导致出血的风险,应引起重视。Objective Explore the clinical characteristics,effective treatment methods,related complications and main causes of death,from critical wasp stings.Methods The study investigated the clinical characteristics of wasp sting and death cases recorded in the Affiliated Hospital of Zunyi Medical University in Guizhou from June 2011 to November 2018.The data collection comes from the emergency and inpatient system of the Affiliated Hospital of Zunyi Medical University.Results A total of 56 wasp sting death patients were collected,accounting for 2.82% of 1 987 patients who were treated.Of these,31 males and 25 females had an average age of(50.8±17.9) years.Cases are distributed in summer and autumn,with the most cases in September and October.The victim suffered extensive stings in exposed parts of the head and neck and torso.It mainly causes liver and renal function damage,abnormal coagulation function,and rhabdomyolysis.Thirty-eight hospitalized patients were treated for blood purification,including 3 with Hemoperfusion(HP),8 with Continuous renal replacement therapy(CRRT),17 with HP + CRRT,10 with HP + CRRT + Plasma exchange(PE),and 12 patients without blood purification.Among them,6 patients immediately performed cardiopulmonary resuscitation(CPR) in the emergency.Conclusion The incidence of wasp sting in northern Guizhou is high,which seriously threatens people’s lives and health.The early cause of death was mostly shock uncontrolled by toxins,and the later cause of death was complicated with multiple organ failure(MOF) and fatal bleeding.Wasp sting should be treated as early as possible,early prevention and treatment of multiple organ dysfunction,choose accurate blood purification and comprehensive treatment,can effectively improve the prognosis,improve the success rate of treatment.

关 键 词：黄蜂蜇伤 多器官功能衰竭 血液净化 出血并发症 预后 

分 类 号：R459.7[医药卫生—急诊医学]