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目的研究血浆置换(PE)联合连续性血液净化(CBP)抢救黄蜂螫伤致多器官衰竭(MOF)的疗效。方法收集2000-07～2005-03十堰市太和医院收治的10例黄蜂螫伤致MOF的患者,除内科常规治疗外,行PE及静脉血液透析(CVVHDF)治疗,治疗前、PE后、CVVHDF结束时,检测肝肾功能、心肌酶学、TNF-α、IL-6、PT水平,并进行ICU监护,观察少尿期、多尿期时间及平均住院日。与50例黄蜂螫伤致肾功能不全患者平均值进行比较。结果在治疗过程中血流动力学稳定,血浆置换后ALT、CPK-MB、TBi、TNF-α、IL-6、PT明显下降(P<0.05),而BUN、Cr下降不明显;CVVHDF治疗后BUN、Cr、TNF-α、IL-6、PT呈进行性下降,与治疗前相比差异显著(P<0.05),而TBi变化不明显;APACHEⅡ评分从(24.76±2.3)下降至(8.73±1.24)(P<0.05),无死亡病例。8例患者平均少尿期(13.5±1.5)d,多尿期(10.5±2.5)d,平均住院日(28.5±5.5)d;50例黄蜂螫伤致ARF患者少尿期均值(15.5±1.37)d,多尿期均值(12.5±2.77)d,平均住院日(30.5±3.57)d,两者比较P>0.05。结论PE联合CVVHDF治疗能有效清除黄蜂螫伤致MOF患者炎症介质TNF-α、IL-6水平,改善肝、肾、心肌、凝血功能,显著改善患者预后。
Objective To study the efficacy of plasma exchange (PE) combined with continuous blood purification (CBP) in the rescue of multiple organ failure (Wasp) caused by gall wasps. Methods A total of 10 cases of wasp-induced MOF were enrolled in Taihe Hospital of Shiyan City from July 2000 to March 2005. Except routine medical treatment, PE and venous hemodialysis (CVVHDF) were performed. Before and after PE, CVVHDF At the end of the experiment, liver and kidney function, myocardial enzyme, TNF-α, IL-6 and PT levels were detected and ICU monitoring was performed. The oliguria period, polyuria period and average length of stay were observed. And 50 cases of wasp caused by renal failure patients with the average value were compared. Results During the treatment, the hemodynamics was stable. The levels of ALT, CPK-MB, TBi, TNF-α, IL-6 and PT were significantly decreased (P <0.05) The levels of BUN, Cr, TNF-α, IL-6 and PT decreased significantly from 24.76 ± 2.3 to 8.73 ± (P <0.05), while TBi did not change significantly 1.24) (P <0.05), no deaths. The average duration of oliguria (13.5 ± 1.5) d, polyuria (10.5 ± 2.5) days and average length of stay (28.5 ± 5.5) days in 8 patients were significantly lower than those in control group (15.5 ± 1.37 ) d, the average duration of polyuria (12.5 ± 2.77) d, the average hospital stay (30.5 ± 3.57) d, both P> 0.05. Conclusions Combination of PE and CVVHDF can effectively eliminate the levels of TNF-α and IL-6 in the inflammatory mediators of the wasp caused by wasps and improve the liver, kidney, myocardium and coagulation function, and significantly improve the prognosis of the patients.