不同血液净化方式治疗蜂蛰伤致急性肾功能衰竭的临床研究

Clinical effects of different blood purification methods in the treatment of acute renal failure caused by wasp sting

摘要:

目的：评价连续性静脉-静脉滤过（continuous venovenous hemofiltration，CVVH）联合血液灌流（hemoperfusion，HP）治疗蜂蛰伤患者急性肾功能衰竭（acute renal failure，ARF）的疗效。方法：72例蜂蛰伤致ARF的患者分成血液透析（haemodialysis，HD）组（n=30）和CVVH/HP组（n=42）。测量治疗24 h后的尿素氮（blood urea nitrogen，BUN）、血肌酐（serum creatinine，Scr）、钾离子（K+）、pH值、β2微球蛋白（β2-microglobulin，β2-MG）和肌红蛋白，记录并比较各组的总有效率，少尿期平均持续时间和平均住院天数。结果：治疗24 h后，２组的BUN、Scr、K 较治疗前均下降，HCO3-和pH值较治疗前均提高（P<0.05）；HD组的β2-MG和肌红蛋白与治疗前相比均无统计学差异（P >0.05）；而CVVH/HP组的β2-MG和肌红蛋白较治疗前下降（P<0.05）。治疗后2组在K 、HCO3-和pH值上均无统计学差异（P >0.05），而CVVH/HP组的BUN、Scr、β2-MG和肌红蛋白低于HD组（P<0.05）。CVVH/HP组的总有效率高于HD组，平均少尿期时间和住院时间均少于HD组（P<0.05）。结论：CVVH联合HP可以很好的纠正电解质及酸碱失衡，有效的清除体内毒性物质，明显改善肾功能和提高患者的预后质量。该方法临床疗效显著，可能是治疗蜂蛰伤致ARF的一个很好的措施。

Abstract:

Objective：To evaluate the effects of continuous venovenous hemofiltration（CVVH） combined with hemoperfusion（HP） in the treatment of acute renal failure（ARF） caused by wasp sting. Methods：Totally 72 patients with ARF caused by wasp sting were divided into haemodialysis（HD） group（n=30） and CVVH/HP group（n=42） based on the different treatments. Blood urea nitrogen（BUN），serum creatinine（Scr），K+，HCO3-，pH，β2-microglobulin（β2-MG） and myoglobin were measured at 24 h after the treatments. The total effective rate，average time of oliguria stage and average time in hospital were recorded and compared between two groups. Results：There were significant decreases in BUN，Scr and K ，and significant increases in HCO3- and pH in both two groups at 24 h after treatment（P<0.05）. There was no difference in β2-MG and myoglobin in HD group before and after the treatment（P >0.05）；however，significant decreases in β2-MG and myoglobin in CVVH/HP group were observed（P<0.05）. There was no significant differ－ence in K ，HCO3- and pH between two groups after the treatment（P >0.05）；but BUN，Scr，β2-MG and myoglobin were significantly lower in CVVH /HP group than in HD group（P<0.05）. The total effective rate in CVVH/HP group was significantly higher than that in HD group，and the average time of oliguria stage and the average time in hospital in CVVH/HP group were significantly shorter than those in HD group（P<0.05）. Conclusion：CVVH combined with HD can markedly correct turbulence of electrolyte and acid-alkali，effectively clear toxic substance in vivo，and significantly improve renal function and prognosis. It is of better clinical effect and may be a good therapeutic measure for ARF caused by wasp sting.