血浆置换与血液灌流对蜂蜇伤所致MODS患者疗效对比  

Comparison of therapeutic effects of plasma exchange and hemoperfusion on MODS patients due to bee stings

作　　者：张嘉宁 肖谦[2] 刘元银 雷淑慧 ZHANG Jianing;XIAO Qian;LIU Yuanyin;LEI Shuhui(The First Clinical College of Chongqing Medical University,Chongqing 400016,China;Department of Geriatric Medicine,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Critical Care Medicine,Tongliang Hospital,the First Affiliated Hospital of Chongqing Medical University,Chongqing 402560,China)

机构地区：[1]重庆医科大学第一临床学院,重庆400016 [2]重庆医科大学附属第一医院老年医学科,重庆400016 [3]重庆医科大学附属第一医院铜梁医院重症医学科,重庆402560

出　　处：《现代医药卫生》2023年第21期3637-3640,3646,共5页Journal of Modern Medicine & Health

基　　金：重庆市卫生健康委员会科卫联合医学科研项目(2019QNXM025);重庆市铜梁区科技局医学科研项目(TL2020-28)。

摘　　要：目的探讨血浆置换与血液灌流治疗对蜂蜇伤所致多器官功能障碍综合征(MODS)患者疗效的差异。方法分析2015年7月至2022年6月重庆医科大学附属第一医院铜梁医院收治的32例蜂蜇伤所致MODS患者的临床资料,按真实世界研究方法,将其中行连续性静脉-静脉血液滤过(CVVH)联合血液灌流治疗者设为对照组(9例),行CVVH联合血浆置换治疗者设为观察组(23例)。对比分析2组患者预后、住院时间,以及治疗前后部分炎症及生化指标变化,包括C反应蛋白、白细胞、肌酸激酶同工酶等。结果2组患者治疗后C反应蛋白、白细胞、肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶、谷草转氨酶、谷丙转氨酶、肌酐均较治疗前明显降低,且观察组患者治疗后肌酐降低更明显,住院时间更短,差异均有统计学意义(P<0.05)。2组患者预后比较,差异无统计学意义(P>0.05)。结论对蜂蜇伤所致MODS患者给予CVVH联合血浆置换与联合血液灌流治疗均有效,且CVVH联合血浆置换的疗效更显著。Objective To explore the difference of therapeutic effects between plasma exchange and hemoperfusion in patients with multiple organ dysfunction syndrome(MODS)due to bee stings.Methods The clinical data of 32 patients with MODS due to bee stings in Tongliang Hospital,the First Affiliated Hospital of Chongqing Medical University from July 2015 to June 2022 were analyzed.According to the real world research method,the patients who underwent continuous venovenous hemofiltration(CVVH)combined with hemoperfusion were set as the control group(9 cases),and those who underwent CVVH combined with plasma exchange were set as the observation group(23 cases).The prognosis,hospitalization time,and changes of some inflammation and biochemical indexes before and after treatment,including C-reactive protein(CRP),white blood cell(WBC),creatine kinase isoenzyme(CK-MB),etc.,were compared and analyzed between the two groups.Results CRP,WBC,creatine kinase,CK-MB,lactate dehydrogenase,AST,ALT and creatinine in the two groups were significantly lower than those before treatment,and Cr in the observation group decreased more obviously after treatment,and the hospitalization time was shorter,with statistically significance differences(P<0.05).There was no statistical difference in prognosis between the two groups(P>0.05).Conclusion Both CVVH combined with plasma exchange and combined hemoperfusion therapy are effective,and CVVH combined with plasma exchange is more effective.

关 键 词：蜂蜇伤 多器官功能障碍综合征 血浆置换 血液灌流 

分 类 号：R459.5[医药卫生—治疗学]