中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (04): 219-223.doi: 10.3969/j.issn.1671-4091.2015.04.009

• 临床研究 • 上一篇    下一篇

重症蜂蛰伤患者腹膜透析与连续性静一静脉血液滤过治疗的比较

王晓明,孙燕,梁衍,高妍婷,冯婷,金刚,鲁艳搏,孙小蕊,李振江   

  1. .陕西省人民医院肾内科
  • 收稿日期:2014-09-29 修回日期:2015-02-08 出版日期:2015-04-12 发布日期:2015-04-20
  • 通讯作者: 李振江 xianwangxm@126.com E-mail:xianwangxm@126.com

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

  • Received:2014-09-29 Revised:2015-02-08 Online:2015-04-12 Published:2015-04-20

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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。

关键词: 重症蜂蜇伤, 腹膜透析, 连续性静-静脉血液透析/滤过

Abstract: Objective To compare the effect of peritoneal dialysis (PD) and continuous vena-vena hemodialysis/ hemofiltration (CVVH) on the patients with bee venom-induced multiple organ dysfunction syndrome(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 (APACHEⅡ score), Hb, WBC, serum Cr, ALT, TBil and CK, dialysis related complications, and dialysis expenses per day were collected. Results There were no differences
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 complications were found in 55% patients in CVVH group, but was only 15.3% patients in PD group (P＞0.05). Therapeutic 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.

Key words: bee venom—induced multiple organ dysfunction syndrome, Peritoneal dialysis, Continuous vena- vena hemodialysis/ hemofiltration