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目的分析以连续性静脉-静脉血液滤过(CVVH)治疗RIFLE标准不同分期的蜂蛰伤并发多器官功能障碍综合征(MODS)患者的疗效,寻找最佳治疗时机。方法回顾性分析成都军区总医院、第三军医大学西南医院和新桥医院2006年以来收治的61例蜂蛰伤并发MODS患者资料,其中16例未行CVVH治疗,设为对照组;另外45例采用RIFLE标准的急性肾损伤(AKI)分期,按CVVH治疗时机分A组(AKIⅠ期开始CVVH治疗)、B组(AKIⅡ期开始CVVH治疗)、C组(AKIⅢ期开始CVVH治疗),严格按标准CVVH治疗。对比分析各组的死亡率、平均ICU住院时间、平均机械通气时间、平均连续血液滤过治疗时间以及蜂蛰伤至开始CVVH治疗的间隔时间,并将CVVH治疗前和治疗24 h后的APACHEⅡ评分、SOFA评分、血IL-6、氧合指数、血肌酐(Cr)、平均动脉压(MAP)等结果进行比较。结果 (1)对照组的死亡率明显高于行CVVH治疗组(P<0.01)。(2)C组CVVH治疗前APACHEⅡ评分、SOFA评分、血IL-6、死亡率以及蜂蛰伤至开始CVVH治疗的间隔时间均明显高于A、B两组(P<0.05)。(3)A、B两组死亡率及CVVH治疗前APACHEⅡ评分、SOFA评分差异无统计学意义,但B组CVVH治疗前IL-6浓度明显高于A组(P<0.05),平均ICU住院时间、平均机械通气时间、平均连续血液滤过治疗时间以及蜂蛰伤至开始CVVH治疗的间隔时间明显长于A组(P<0.01)。(4)A、B、C三组CVVH治疗24 h后血IL-6、氧合指数、Cr、MAP均明显改善(P<0.01),但C组IL-6仍高于A、B两组(P<0.05);A、B两组CVVH治疗24 h后APACHEⅡ评分、SOFA评分降低(P<0.01),C组治疗24 h后与治疗前相比差异无统计学意义。结论 CVVH是治疗蜂蛰伤并发MODS的一种有效手段,RIFLE标准对判断CVVH的治疗时机有指导意义,AKIⅠ期和Ⅱ期行CVVH可明显改善蜂蛰伤并发MODS的预后,而AKIⅠ期行CVVH的疗效更佳。
Objective To analyze the curative effect of continuous veno-venous hemofiltration (CVVH) on bee stings complicated with multiple organ dysfunction syndrome (MODS) in different staging of RIFLE and find out the optimal timing of treatment. Methods A retrospective analysis of data from 61 cases of MODS patients with sting from bee stings in Chengdu Military Region General Hospital, Southwest Hospital of Third Military Medical University and Xinqiao Hospital since 2006 was performed. Among them, 16 cases were treated with CVVH without treatment, and the other 45 cases Acute renal injury (AKI) staging with RIFLE criteria was divided into group A (CVVH treatment in AKI stage I), CVVH treatment in group AKI (stage CVIH treatment in AKI stage II), and CVVH treatment in group C (AKI stage III) according to the standard of CVVH CVVH treatment. The mortality, mean length of ICU stay, mean duration of mechanical ventilation, mean duration of continuous hemofiltration, and time between the onset of CVVH and the onset of CVVH were compared between the groups. The APACHE II score before and 24 h after CVVH , SOFA score, blood IL-6, oxygenation index, serum creatinine (Cr), mean arterial pressure (MAP) and other results were compared. Results (1) The mortality rate of the control group was significantly higher than that of the CVVH treatment group (P <0.01). (2) The APACHEⅡscore, SOFA score, blood IL-6, and the time interval between the onset of CVVH and the onset of CVVH in group C before treatment were significantly higher than those in group A and B (P <0.05). (3) Mortality of A and B groups and APACHEⅡscore and SOFA score before CVVH treatment were not statistically different, but the concentration of IL-6 in group B before CVVH treatment was significantly higher than that in group A (P <0.05) , Mean duration of mechanical ventilation, mean duration of continuous hemofiltration, and interval between onset of CVVH and sting after bee sting were significantly longer than those in group A (P <0.01). (4) The level of IL-6, oxygenation index, Cr and MAP were significantly improved in group A, B and C after 24 h of CVVH treatment (P <0.01) (P <0.05). APACHEⅡscore and SOFA score decreased after CVVH treatment for 24 h in groups A and B (P <0.01). There was no significant difference in 24 h between C group and before treatment. Conclusions CVVH is an effective method for the treatment of MODS with bee stings. RIFLE standard is of guiding significance in judging the timing of CVVH treatment. In the first and second phase of AKI, CVVH can significantly improve the prognosis of MODS with bee stings and AKI, The effect is better.