蜂蛰伤致横纹肌溶解症强化治疗策略的初步研究

目的:研究以肌酸激酶升高值结合SOFA评分为时机,进行包括激素冲击、适时血液净化和局部持续湿敷的强化方案对蜂蛰伤造成的横纹肌溶解症预后的影响。方法:收集整理2009年1月至2015年12月我院急诊科收治的蜂蛰伤患者的临床资料,按肌酸激酶升高值分为对照组和治疗组,对照组进行常规治疗,治疗组进行早期激素冲击、以SOFA评分为时机进行血液净化和局部持续治疗。比较入院后两组患者横纹肌损伤程度和基本治疗情况,比较两组患者治疗1周后脏器功能情况,比较两组患者严重并发症和预后。结果:治疗组横纹肌溶解程度较对照组重(P0.05),其补液量、补碱量、激素用量及循环负荷均多于对照组(P0.05),SOFA评分高于对照组(P0.05);治疗1周后治疗组脏器功能情况较对照组明显改善(P0.05);治疗组患者急性肾损伤、高钾血症、过敏性休克和多器官功能障碍发生率及病死率低于对照组(P0.05)。结论:以肌酸激酶升高程度结合SOFA评分作为依据,进行早期激素冲击、适时血液净化和局部持续治疗,这种强化治疗方案有利于脏器功能改善和预后。

A Preliminary Study on the Intensive Strategy of Rhabdomyolysis Induced by Bee Sting

Objective:To research the effect on prognosis of rhabdomyolysis induced by bee sting, using the intensive strategy including glucocorticoids ictus therapy, blood purification at appropriate timing and continual wet pack, according to the increase of creatine kinase value combined with SOFA score as the timing.Methods:The clinical data of patients with bee sting injury was collected from January 2009 to December 2015 in our emergency department. The patients were divided into control group and treatment group according to the value of creatine kinase. Control group was treated with routine treatment. Treatment group was treated with early glucocorticoids ictus therapy, blood purification according to SOFA score and local continuous treatment. The degree of striated muscle injury, basic treatment, organ function after one week of treatment, severe complications and prognosis were analyzed beween the two groups.Results:The degree of striated muscle injury of the treatment group was more serious than the control group(P<0.05). The amount of fluid, alkali, dosage of hormone and cyclic load of the treatment group were more than the control group (P<0.05), and the SOFA score was also higher (P<0.05). The organ function of the treatment group was significantly improved compared with the control group after one week treatment(P<0.05). Both the incidence rate of acute renal injury, high potassium, allergic shock, multiple organ dysfunction and the mortality rate of the treatment group were lower than that of the control group (P<0.05).Conclusion:Organ function and prognosis were both improved by the intensive strategy including glucocorticoids ictus therapy, blood purification at appropriate timing and continual wet pack according to the increase of creatine kinase value combined with SOFA score as the timing.