中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (10): 591-595.doi: 10.3969/j.issn.1671-4091.2015.10.005

• 临床研究 • 上一篇    下一篇

双重血浆分子吸附系统在蜂蛰伤致多器官功能衰竭中的应用

赵明,李向东,李毅,沈海燕,郭博慧,翟英   

  1.  陕西省汉中三二零一医院肾内科
  • 收稿日期:2015-04-27 修回日期:2015-08-04 出版日期:2015-10-12 发布日期:2015-10-12
  • 通讯作者: 李向东 boyang_1996@qq.com E-mail:boyang_1996@qq.com

Application of the double plasma molecular absorption system for the multiple organ failure patients due to bee stings injury

  • Received:2015-04-27 Revised:2015-08-04 Online:2015-10-12 Published:2015-10-12

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摘要： 目的 探讨双重血浆分子吸附系统(DPMAs)治疗蜂蛰伤致多器官功能衰竭的临床疗效。方法 回顾性分析58 例蜂蛰伤致多器官功能衰竭患者，根据血液净化方式不同分为双重血浆分子吸附系统和持续静脉静脉血液滤过(DPMAs+CVVH)组(21 例)、血液灌流和持续静脉静脉血液滤过(HP+CVVH)组(20 例)、血浆置换和持续静脉静脉血液滤过(PE+CVVH)组(17 例)。观察3 组治疗前、治疗3 天后血肌红蛋白(Mb)、肌酸激酶(CK)、天门冬氨酸转移酶(AST)、总胆红素(TBIL)、血肌酐(Sr)、降钙素原(PCT)等水平变化，记录3 组相应APACHⅡ评分变化，并观察临床疗效。结果与治疗前相比3 组患者在治疗3 天后的血肌红蛋白(Mb)下降明显(P＜0.01),肌酸激酶(CK)、天门冬氨酸转移酶(AST)、总胆红素(TBIL)、血肌酐(Sr)、APACHEII 评分和降钙素原(PCT)指标下降明显(P＜0.05)。与HP+CVVH 组、PE+CVVH 组比较DPMAS+CVVH 组治疗3 天后的血肌红蛋白(Mb)、肌酸激酶(CK)、天门冬氨酸转移酶(AST)、总胆红素(TBIL)、血肌酐(Sr)、APACHEII 评分和降钙素原(PCT)下降更为明显[Mb(F=15.277，P=0.015)；CK(F=5.560，P=0.027);AST(F=4.011，P=0.025);TBIL(F=5.529，P=0.007);Scr(F=5.201，P=0.018); APACHEII 评分(F=8.821，P=0.001);PCT(F=19.351,P=0.003)]。DPMAs+CVVH 组患者持续无尿或少尿时间较其他2 组明显减少(F=8.141，P=0.001)，患者酱油色尿消失例数多于其他2 组(χ2=11.043，P=0.004)，该组患者治愈率、死亡率、总有效率优于其他2 组[治愈率(χ2=6.115，P=0.047)；死亡率(P=0.000)；总有效率(χ2=12.429，P=0.02)]。结论 DPMAS 可高效清除蜂蛰伤致多器官功能衰竭状态下的毒性物质，阻断其脏器功能损害的病理生理机制，是蜂蛰伤致多器官功能衰竭综合救治的有效措施之一,有改善预后作用，值得临床推广应用。

关键词: 双重血浆分子吸附系统, 蜂蜇伤, 多器官功能衰竭

Abstract: Objective To investigate the prognosis of patients with bee stings induced multiple organ failure (MOF) and treated with double plasma molecular absorption system (DPMAs). Methods A total of 58 cases of patients with bee stings injury and MOF were retrospectively analyzed. They were treated with blood purification and divided into three groups: DPMAs and continuous veno- venous hemofiltration (CVVH) (DPMAs-CVVH) group (n=20), hemoperfusion and CVVH (HP-CVVH) group (n=21), and plasma exchange and CVVH (PE-CVVH) group (n=17). Before treatment and after treatment for 3 days, serum myoglobin, creatinekinase, AST, total bilirubin, creatinine and procalcitonin were determined, and APACH II score and clinical conditions were evaluated. Results APACH II score and serum myoglobin, creatinekinase, AST, total bilirubin, creatinine and procalcitonin reduced significantly after the treatment in the three groups (P＜0.05). After the treatment for 3 days, myoglobin, creatinekinase, AST, total bilirubin, creatinine, procalcitonin and APACH II score decreased more in DPMAs-CVVH group than in HP-CVVH and PE-CVVH groups (P＜0.05). Additionally, clinical symptoms and patients’prognosis also improved more in DPMAs-CVVH
group than in HP-CVVH and PE-CVVH groups (P＜0.05). Conclusions DPMAs can effectively prevent organ dysfunction and improve clinical symptoms and prognosis through clearance of the toxicants. Therefore, DPMAs-CVVH is an important measure in the comprehensive treatments for MOF patients due to bee
stings.

Key words: Double plasma absorption system, Bee stings injury, Multiple organ failure