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目的:提高群蜂蛰伤致急性肾衰竭(ARF)的诊断和治疗水平。方法:回顾性分析我科7年来收治的23例群蜂蛰伤致ARF的临床资料,初步探讨其疗效及死因等。结果:23例群蜂蛰伤致急性肾功能衰竭患者,少尿型ARF为20例(占87%)无尿型ARF为3例(占13%);均伴有心肌酶、肌酸激酶、乳酸脱氢酶、谷丙转氨酶(ALT)升高;主要并发症为中毒性心肌炎(23/23,100.0%)、横纹肌溶解肌症(23/23,100.0%)、血红蛋白尿(21/23,91.3%)、血管内溶血(21/23,91.3%)、中毒性肝炎(16/23,69.6%)等;入院后12h内,10例行血液透析(hemodialysis,HD),13例行血液灌流(he-moperfusion,HP)/透析联合治疗(HP/HD);两组患者总治愈好转率为87.0%,病死率为13.0%;其中HD组治愈好转率为70.0%(7/10),病死率为30%(3/10),HP/HD组治愈好转率为100%(13/13),病死率为0,两组间疗效存在显著差异(P=0.034);但所观察的病例中,HD组为我科前3年治疗蜂毒致ARF的方案,HP/HD组为我科后4年主要治疗蜂毒致ARF的方案,组间存在时间差异,并且病例数亦较少,因此两组的疗效对比有待进一步研究。3例患者死亡原因为多系统脏器功能衰竭(MSOF)。结论:蜂毒中毒所致急性肾功能衰竭以少尿型为主,同时伴有心、肝、血液、神经系统等重要组织器官的损伤,病情重;患者主要死亡原因为全身多系统器官功能衰竭(MSOF);尽早行血液净化是治疗群蜂蛰伤有效手段,其中条件允许的医院建议首选HP/HD联合治疗。
Objective: To improve the diagnosis and treatment of acute renal failure (ARF) caused by stings in swarms. Methods: The clinical data of 23 ARF patients treated by stings were analyzed retrospectively in our department in the past 7 years, and the curative effect and cause of death were discussed. Results: Twenty-three patients (13%) had urinary ARF were found in 20 cases (87%) with ARF of oliguric type in 23 cases of acute renal failure caused by hernia stings. All patients had myocardial enzymes, creatine kinase, lactate Dehydrogenase and alanine aminotransferase (ALT). The main complications were toxic myocarditis (23/23, 100.0%), rhabdomyolysis (23/23, 100.0%), hemoglobinuria (21/23, 91.3% Hemolysis (21/23, 91.3%), toxic hepatitis (16/23, 69.6%), etc. Within 12 hours after admission, hemodialysis (hemodialysis, HD) and hemodialysis HP / dialysis combination therapy (HP / HD); The two groups of patients were cured rate was 87.0%, the mortality rate was 13.0%; HD group cured improvement rate was 70.0% (7/10), the case fatality rate was 30% 3/10), the cure rate of HP / HD group was 100% (13/13), and the case fatality rate was 0, there was significant difference between the two groups (P = 0.034); however, among the observed cases, The first 3 years of treatment of bee venom caused by ARF program, HP / HD group for 4 years after my main treatment of bee venom caused by ARF program, there are time differences between groups, and the number of cases is also less, so the two groups compared the efficacy For further study. Three patients died of multiple system organ failure (MSOF). Conclusions: Acute renal failure caused by bee venom poisoning is mainly oliguria, accompanied by injury to important tissues and organs such as heart, liver, blood and nervous system. The main cause of death is systemic multiple organ failure MSOF); as soon as possible blood purification is an effective means of treatment stinger herd bees, where the conditions allow the hospital recommended HP / HD combination therapy.