CAJ | 학술논문

目的：通过对糖皮质激素联合血液灌流( HP)+血液透析( HD)及激素联合连续性静脉-静脉血液净化治疗( CVVH)+血液灌流治疗蜂蛰伤并发多器官功能障碍患者临床疗效的观察,探讨蜂蛰伤的治疗策略。方法选择2012年4月至2013年9月在我院肾内科住院且均接受了激素联合血液净化治疗的蜂蛰伤并发多器官功能障碍患者31名,分为A、B两组,其中A组予甲基强的松龙(1次/d)联合HP+HD(1次/d)治疗,B组予甲基强的松龙(1次/d)联合CVVH+HP(1次/d)治疗,3d后检测血白细胞总数( WBC)、谷草转氨酶( AST)、总胆红素( TBIL)、肌钙蛋白( cTn)、肌酸激酶( CK)、肌红蛋白( MYO)及尿素氮( BUN)、肌酐( Cr)、C反应蛋白( CRP)。结果 A、B两组治疗前、后比较,治疗后WBC、AST、TBIL、cTn、CK及MYO、BUN、Cr、CRP均显著下降,较治疗前差异有统计学意义(P<0．05)。治疗后A、B组间比较,B组BUN、Cr及CK、CRP下降更加显著(P<0．05)。结论激素联合CVVH+HP治疗蜂蜇伤并发多器官功能障碍综合征患者较HD+HP更有优势。
목적：통과대당피질격소연합혈액관류( HP)+혈액투석( HD)급격소연합련속성정맥-정맥혈액정화치료( CVVH)+혈액관류치료봉칩상병발다기관공능장애환자림상료효적관찰,탐토봉칩상적치료책략。방법선택2012년4월지2013년9월재아원신내과주원차균접수료격소연합혈액정화치료적봉칩상병발다기관공능장애환자31명,분위A、B량조,기중A조여갑기강적송룡(1차/d)연합HP+HD(1차/d)치료,B조여갑기강적송룡(1차/d)연합CVVH+HP(1차/d)치료,3d후검측혈백세포총수( WBC)、곡초전안매( AST)、총담홍소( TBIL)、기개단백( cTn)、기산격매( CK)、기홍단백( MYO)급뇨소담( BUN)、기항( Cr)、C반응단백( CRP)。결과 A、B량조치료전、후비교,치료후WBC、AST、TBIL、cTn、CK급MYO、BUN、Cr、CRP균현저하강,교치료전차이유통계학의의(P<0．05)。치료후A、B조간비교,B조BUN、Cr급CK、CRP하강경가현저(P<0．05)。결론격소연합CVVH+HP치료봉철상병발다기관공능장애종합정환자교HD+HP경유우세。
Objective Observe the treatment and hemoperfusion in the bee sting injury complicated with multiple organ dysfunction syndrome ( MODS) in patients with clinical efficacy to hormone combined with hemoperfusion ( HP) plus hemodialy-sis ( HD) and hormone combined with continuous veno venous hemofiltration ( CVVH) plus hemoperfusion ( HP) , which explore the bee sting therapy strategy. Methods Choose 31 patients in nephrology department in our hospital from April of 2012 to Sep-tember of 2013 were treated by hormone combined with blood purification treatment of bee sting injury complicated with MODS, which were randomly divided into A and B groups, the group A was treated with methylprednisolone (1 times / day)combined with HP+HD (1 times daily)therapy, the group B was treated with methylprednisolone (1 times / day)combined with CVVH+HP (1 times daily ) . The white blood cell count ( WBC) , glutamic-oxalacetic transaminase( AST) , totalbilirubin ( TBIL) ,cardiactroponi-nI ( cTn) , creatine kinase ( CK) , myoglobin ( MYO) and blood urea nitrogen ( BUN) , serum creatinine ( Cr) , C reactive protein (CRP)were detected after 3 days. Results Compare the WBC,AST, TBIL, cTn, CK and MYO, BUN, Cr, CRP with before treatment and after treatment which were significantly decreased in A and B groups(P<0. 05). compared with those before treat-ment had significant difference (P<0. 05). Compare A and B groups with After treatment, the BUN, Cr and CK, CRP decreased significantly in B groups(P<0. 05). Conclusion The treatment of hormone combined with CVVH+HP for bee sting i patients complicated with multiple organ dysfunction syndrome have more advantages than HD+HP.