CAJ | 학술논문

目的探讨序贯性血液净化方法治疗马蜂蜇伤致蜂中毒并多器官功能障碍综合征(MODS)的疗效.方法对武汉市儿童医院1 1例马蜂蜇伤并MODS的患儿进行序贯性血液净化治疗,中毒早期及时给予血浆置换(PE)、血液灌流(HP)清除毒素,同时序贯连续性肾脏替代治疗(CRRT),疾病好转期进行间断血液透析(IHD),不同时期应用不同净化模式治疗.采用回顾性分析的方法观察患儿治疗前后肝肾功能、心肌酶谱等变化趋势,总结血液净化治疗的效果.结果 11例患儿中10例予HP、CRRT和IHD治疗,6例在入院第1天进行PE治疗.1例年龄最小的患儿在入院不到24 h因中毒性心肌炎突发心律失常死亡.10例患儿经治疗心肌酶谱首先恢复正常,其次,黄疸和肝功能好转,治疗10 d后肾功能逐渐好转.出院2周后回访复查肝肾功能、心肌酶谱各项指标完全恢复正常.尿常规复查5例患儿有镜下血尿,3例有血尿并蛋白尿,2例尿常规完全正常.好转治愈率为91％(10/11例).结论早期及时采用多种血液净化模式序贯治疗是救治重症蜂中毒并MODS患儿的主要有效的手段.
목적 탐토서관성혈액정화방법치료마봉철상치봉중독병다기관공능장애종합정(MODS)적료효.방법 대무한시인동의원1 1례마봉철상병MODS적환인진행서관성혈액정화치료,중독조기급시급여혈장치환(PE)、혈액관류(HP)청제독소,동시서관련속성신장체대치료(CRRT),질병호전기진행간단혈액투석(IHD),불동시기응용불동정화모식치료.채용회고성분석적방법관찰환인치료전후간신공능、심기매보등변화추세,총결혈액정화치료적효과.결과 11례환인중10례여HP、CRRT화IHD치료,6례재입원제1천진행PE치료.1례년령최소적환인재입원불도24 h인중독성심기염돌발심률실상사망.10례환인경치료심기매보수선회복정상,기차,황달화간공능호전,치료10 d후신공능축점호전.출원2주후회방복사간신공능、심기매보각항지표완전회복정상.뇨상규복사5례환인유경하혈뇨,3례유혈뇨병단백뇨,2례뇨상규완전정상.호전치유솔위91％(10/11례).결론 조기급시채용다충혈액정화모식서관치료시구치중증봉중독병MODS환인적주요유효적수단.
Objective To study the efficacy of sequential blood purification treatment of bee poisoning complicated by multiple organ disfunction syndrome (MODS).Methods The 11 cases of children with bee poisoning and MODS from Wuhan Children's Hospital were treated with sequential blood purification therapy,and they were treated with plasma exchange (PE),hemoperfusion (HP) and sequential continuous renal replacement therapy (CRRT) simultaneously in the early stage,and then were treated with intermittent hemodialysis (IHD) in the remission stage.Different modes of purification treatment were applied in different stages.The trends of liver function,renal function and myocardial enzymes were observed in 11 cases before and after therapy,later a retrospective analysis was performed,and the efficacy of sequential blood purification was studied.Results Ten in 11 cases of children were treated with HP,CRRT and IHD therapy,and among them 6 cases were treated with PE on the first day of admission.One case,the youngest of children admitted to hospital less than 24 hours,died of sudden cardiac arrhythmia due to toxic myocarditis.In ten cases of the children after treatment,their myocardial enzymes returned to normal at first,and then jaundice and hepatic function improved,and renal function gradually improved after 10 days.Two weeks after discharge,through reviewing of the liver and kidney function,myocardial enzymes returned to normal indicators.In review of urine,5 cases were accompanied with microscopic hematuria,3 cases were accompanied with hematuria and proteinuria,and 2 cases were completely normal.The improved cure rate was 91％ (10/11 cases).Conclusions Sequential blood purification treatment is the main and effective means for severe bee poisoning complicated with MODS in children in the early stage.