连续性静脉―静脉血液滤过对蜂蛰中毒后多器官功能障碍综合征患者血流动力学与炎症介质清除效能及预后影响分析.docVIP

连续性静脉―静脉血液滤过对蜂蛰中毒后多器官功能障碍综合征患者血流动力学与炎症介质清除效能及预后影响分析 　　[摘要] 目的 探讨连续性静脉-静脉血液滤过（CVVH）对蜂蛰中毒后多器官功能障碍综合征（MODS）患者的疗效。 方法 选取重庆市江津区中心医院自2010年10月～2016年10月收治的马蜂蛰伤中毒后并发多器官功能障碍综合征的48例患者的临床资料进行回顾性分析，根据后续血液净化方案，分为实验组与对照组，每组各24例。两组最初均予以血流灌注（HP）治疗，而后实验组予以CVVH治疗，对照组予以间歇性血液透析（IHD）治疗。治疗1周后，对两组疗效以及预后情况进行评价和比较。 结果 治疗后，实验组APACHE Ⅱ评分和MODS评分均低于对照组（P 0.05），实验组血流动力学指标改善情况显著优于对照组（P 0.05），实验组IL-6水平显著低于对照组（P 0.05），实验组SOFA评分显著低于对照组（P 0.05）。结论 CVVH用于治疗蜂蛰伤中毒后MODS，在清除炎性介质方面效果显著，同时对于改善患者血流动力学水平以及预后均有重要意义，适合推广。 　　[关键词] 连续性静脉-静脉血液滤过；马蜂；多器官功能障碍综合征 　　[中图分类号] R646 [文献标识码] A [文章编号] 1673-7210（2017）09（a）-0023-04 　　[Abstract] Objective To study the effect of continuous veno-venous hemofiltration （CVVH） on patients with multiple organ dysfunction syndrome （MODS） after wasp sting poisoning. Methods The clinical data of 48 cases with MODS after wasp sting poisoning in Center Hospital of Jiangjin District from October 2010 to October 2016 were retrospectively analyzed. They were divided into experimental group （24 cases） and control group （24 cases） according to the hemopurification program. All the patients were treated by blood perfusion （HP）； then the experimental group was treated by CVVH， and the control group was treated by intermittent hemodialysis （IHD）. One week after treatment， the curative effect and prognosis of the two groups were evaluated and compared. Results After treatment， the scores of APACHE II and MODS in the experimental group were lower than those in the control group （P 0.05）. The change of hemodynamic indexes in the experimental group was better than that in the control group （P 0.05）. The IL-6 level in the experimental group was lower than that in the control group （P 0.05）. The SOFA score in the experimental group was lower than that in the control group （P 0.05）. Conclusion CVVH can remarkably remove the inflammatory media， improve the hemodynamic level and prognosis of patients with MODS after wasp sting poisoning， which is worthy of clinical application. 　　[Key words]