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目的:观察不同血液净化方式对蜂蜇伤所致急性肾功能衰竭预后的影响。方法:回顾性分析我院1997至2007年收治的共81例蜂蜇伤患者,其中66例(80.2%)出现急性肾功能衰竭(ARF),60例(74.1%)出现多器官功能障碍(MODS)。64例ARF患者采用血液净化治疗(APACHE评分:19.2±4.6):(1)CVVH/IHD组:前期行连续性静-静脉血液滤过(CVVH)治疗24～72h,情况稳定后给予间歇性血液透析(IHD)治疗。(2)IHD组:采用IHD 1周3次治疗。(3)腹膜透析(PD)组:使用持续性非卧床腹膜透析(CAPD)治疗。使用SPSS 11.0软件进行统计学分析。结果:3组患者治疗前APACHE评分无统计学差异[(19.0±3.5)vs(18.6±5.2)vs(17.8±3.9),P>0.05]。(1)CVVH/IHD组:19例(95%)患者好转出院,1例(5%)患者死亡。(2)IHD组:30例患者(78.9%)好转出院,3例患者(7.9%)死亡,5例患者(13.2%)失访。(3)PD组:无一例患者好转,2例(33.3%)死亡,3例(50.0%)转为终末期肾脏疾病(ESRD),1例失访。CVVH/IHD组及IHD组患者生存率及临床好转率均明显优于PD组。CVVH/IHD组与IHD组相比较,在生存率及临床好转率无显著性差异(P>0.05);但在早期总胆红素、肌酸激酶及白细胞的下降程度明显优于IHD组(P<0.05)。而且在不良反应上(低血压),CVVH/IHD组低于IHD组。结论:前期CVVH可能有利于患者受损器官功能的恢复,缩短患者的住院时间,但能否提高患者的生存率还有待进一步研究证实。CAPD疗效差,不应作为首选治疗。
Objective: To observe the effect of different blood purification methods on the prognosis of acute renal failure caused by bee stings. Methods: A total of 81 patients with bee stings were enrolled in our hospital from 1997 to 2007. Acute renal failure (ARF) occurred in 66 cases (80.2%) and multiple organ dysfunction (MODS) in 60 cases (74.1%). ). Sixty-four ARF patients were treated with blood purification (APACHE score: 19.2 ± 4.6): (1) In the CVVH / IHD group, continuous intravenous hemofiltration (CVVH) was performed for 24 to 72 hours and was given intermittent blood Dialysis (IHD) treatment. (2) IHD group: treated with IHD three times a week. (3) Peritoneal Dialysis (PD) group: Treatment with continuous ambulatory peritoneal dialysis (CAPD). Statistical analysis was performed using SPSS 11.0 software. Results: There was no significant difference in APACHE score between the three groups before treatment (19.0 ± 3.5 vs 18.6 ± 5.2 vs 17.8 ± 3.9, P> 0.05). (1) In the CVVH / IHD group, 19 patients (95%) were discharged after improvement, and 1 patient (5%) died. (2) In the IHD group, 30 patients (78.9%) were discharged, 3 patients (7.9%) died and 5 patients (13.2%) were lost. (3) In the PD group, none of the patients improved, 2 (33.3%) died, 3 (50.0%) were converted to end-stage renal disease (ESRD) and 1 lost. The survival rate and clinical improvement rate of CVVH / IHD group and IHD group were significantly better than PD group. Compared with IHD group, CVVH / IHD group showed no significant difference in survival rate and clinical improvement rate (P> 0.05); however, the decline of total bilirubin, creatine kinase and leukocyte in early stage was significantly better than that in IHD group <0.05). And adverse reactions (hypotension), CVVH / IHD group was lower than the IHD group. Conclusions: Pre-CVVH may be beneficial to the recovery of impaired organ function in patients and shorten the hospitalization time. However, further study is needed to confirm whether CVVH can improve the survival rate of patients. CAPD poor efficacy, should not be the preferred treatment.