早期序贯性血液灌流联合糖皮质激素治疗急性蜂蜇伤横纹肌溶解症的疗效观察

doi:10.3969/j.issn.1006-6233.2020.09.034

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摘要 目的: 观察早期序贯性血液灌流(HP)联合糖皮质激素治疗急性蜂蜇伤横纹肌溶解症(RM)的疗效。方法: 选取2017年5月至2019年10月我院收治的108例急性蜂蜇伤致RM患者,按简单随机数字表法将所有患者以1:1的比例分为对照组与研究组,每组各54例,对照组患者使用常规方法+早期序贯性HP进行治疗,研究组患者在对照组基础上使用糖皮质激素进行治疗。对比两组患者治疗前、治疗后72h生化指标[肌酸激酶(CK)、肌红蛋白(Myo)、血清肌酐(SCr)、尿氮素(BUN)]、炎症指标[肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)、降钙素原(PCT)]、病情状况(APACHEⅡ评分)差异,并记录预后情况[住院时间,急性肾损伤3期(AKI 3期)、多器官功能障碍综合征(MODS)及死亡发生情况]。结果: 治疗后72h,两组患者CK、Myo、SCr、BUN、TNF-α、IL-6、PCT、APACHEⅡ评分较治疗前均显著降低(P<0.05),且研究组患者上述指标与同期对照组对比差异有统计学意义(P<0.05)。研究组患者住院时间,AKI 3期发生率、MODS发生率及死亡率均显著低于对照组,差异有统计学意义(P<0.05)。结论: 对于急性蜂蜇伤致横纹肌溶解症患者,应用早期序贯性血液灌流联合糖皮质激素治疗效果显著,可明显改善生化指标,降低炎症反应,改善预后,有较好的应用价值。

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关键词 ：急性蜂蜇伤, 横纹肌溶解症, 序贯性血液灌流, 糖皮质激素

Abstract：Objective: To observe the effectiveness of early sequential hemoperfusion (HP) combined with glucocorticoid in the treatment of acute rhabdomyolysis (RM) with bee stings.Methods: A total of 108 patients with RM with bee stings in our hospital from May 2017 to October 2019 were selected and evenly divided into control group and study group with the simple random number table method.Patients in control group had the conventional treatment plus early sequential HP, and patients in study group had glucocorticoid on the basis of control group.The biochemical indicators [creatine kinase (CK), myoglobin (Myo), serum creatinine (SCr), blood urine nitrogen (BUN)], inflammatory indicators [tumor necrosis factor (TNF-α), interleukin-6 (IL-6), procalcitonin (PCT)] and disease status (APACHEⅡ score) were compared between the two groups before treatment and 72h after treatment, and the prognosis status [hospital stay, Acute Kidney Injury stage 3 (AKI stage 3), Multiple Organ Dysfunction Syndrome (MODS) and occurrence of mortality] were recorded.Results: 72h after treatment, the levels of CK, Myo, SCr, BUN, TNF-α, IL-6 and PCT and APACHEⅡ score in the two groups were significantly decreased compared with those before treatment (P<0.05), and there were statistically significant differences in the above indexes in study group compared with those in control group (P<0.05).The hospital stay, incidence rate of AKI stage 3, incidence rate of MODS and mortality rate in study group were significantly lower than those in control group (P<0.05).Conclusion: For patients of acute rhabdomyolysis with acute bee stings, early sequential hemoperfusion combined with glucocorticoid has significant curative effects, and it can significantly improve biochemical indicators, reduce inflammatory response, and improve prognosis, with good application value.

Key words： Bee stings Acute rhabdomyolysis Sequential hemoperfusion Glucocorticoid

基金资助:海南计生卫生行业科研项目,(编号:14A200023)

通讯作者: 王小智

引用本文:

黎陛上, 王小智, 李翠. 早期序贯性血液灌流联合糖皮质激素治疗急性蜂蜇伤横纹肌溶解症的疗效观察[J]. 河北医学, 2020, 26(9): 1551-1556.
LI Bishang, et al. Curative Effectiveness Observation of Early Sequential Hemoperfusion Combined with Glucocorticoid on Acute Rhabdomyolysis with Bee Stings. HeBei Med, 2020, 26(9): 1551-1556.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2020.09.034 或 http://www.hbyxzzs.cn/CN/Y2020/V26/I9/1551