蜂蜇伤致多器官功能障碍综合征的危险因素分析

魏炯; 何敏; 胡爱琼; 刘新君

doi:10.3969/j.issn.1671-2390.2017.06.008

摘要: 目的探讨蜂蜇伤致多器官功能障碍综合征（multiple organ dysfunction syndrome，MODS）的危险因素。方法选择四川省巴中市中心医院2010年1月至2015年12月收治的168例蜂蜇伤患者的临床资料，按照是否发生MODS分为MODS组（12例）和非MODS组（156例）。2组均给予补液、激素等一般对症治疗。病情较重溶血明显者及时进行大剂量激素冲击及杂合式序贯性给予血浆置换、血液灌流、连续性肾脏替代治疗、间歇性血液透析等处理。对比分析2组患者入院后第一个24 h的一般情况、MODS发生情况及实验室检查白细胞计数（white blood cell，WBC）、血红蛋白（hemoglobin，Hb）、血钾、二氧化碳结合力（carbon dioxide combining power，CO₂-CP）、心肌肌钙蛋白I（cardiac troponin I，cTnI）、肌酸激酶同工酶（creatine kinase isoenzyme，CK-MB）、凝血酶原时间（prothrombin time，PT）、尿素氮（BUN）、血肌酐（SCr）、丙氨酸氨基转移酶（alanine aminotransferase，ALT）、天门冬氨酸氨基转移酶（aspartate aminotransferase，AST）、总胆红素（total bilirubin，TBIL）、总胆固醇（total cholesterol，TC）；并采用多因素Logistic回归法分析蜂蜇伤致MODS的危险因素。结果 2组患者性别比较差异无统计学意义。患者序贯器官衰竭评分（Sequential Organ Failure Assessment，SOFA）评分> 10分的病死率（占23.7%）高于SOFA评分< 10分者（占5.2%），差异均有统计学意义（P均< 0.01）。2组患者入院后第一个24 h实验室检查结果显示，MODS组患者WBC、CO₂-CP、cTnI、CK-MB、PT、BUN、SCr、ALT、AST、TBIL、TC均较非MODS组明显上升，MODS组Hb、血钾较非MODS组明显下降，差异均有统计学意义（P均< 0.01）。依据临床相关危险因素选取以下条件指标进行分界分析，年龄> 55岁、蜂蜇伤至入院时间≥ 6 h、WBC > 20×10⁹/L、Hb < 90 g/L、血钾> 5.5 mmol/L、CO₂-CP > 20 mmol/L、cTnI > 0.7 μg/L、CK-MB > 60 U/L、PT > 15 s、BUN > 14 mmol/L、SCr > 171 μmol/L，与相对应的单个因素比较差异均有统计学意义（P均< 0.01）。通过以上因素分析显示，均是蜂蜇伤患者发生MODS的独立危险因素（P < 0.05或P < 0.01）。结论年龄、蜂蜇伤至入院时间、WBC、Hb、血钾、CO₂-CP、cTnI、CK-MB、PT、BUN、SCr水平均是蜂蜇伤患者发生MODS的独立危险因素。及早进行一般治疗、激素及血液净化干预，尽可能避免出现本研究中发生MODS相关的独立危险因素，为减少发生MODS的概率提供重要依据。

Abstract: Objective To explore the risk factors of multiple organ dysfunction syndrome (MODS) caused by bee stings.Methods The clinical data of 168 cases of bee sting patients in Bazhong Hospital from Jan. 2010 to Dec. 2015 were selected and the patients were divided into MODS group (12 cases) and non-MODS group (156 cases) according to the occurrence of MODS. General situation, the occurrence of MODS and auxiliary examination results in two groups were comparatively analyzed and the risk factors of MODS caused by bee sting injury were analyzed by Multi factor Logistic regression method.Results There was no significant difference in gender of patients between the two groups. The mortality rate of patients whose Sequential Organ Failure Assessment (SOFA) score > 10 was higher than that with SOFA score <10 and the difference was statistically significant (P<0.01). According to the following criteria for the demarcation of the basis and analysis:age >55 years, the duration from bee stings to hospitalization ≥ 6 h, white blood cell count (WBC) >20×10⁹/L, hemoglobin (Hb) <90 g/L, blood potassium (K⁺) >5.5 mmol/L, carbon dioxide combining power (CO₂-CP) >20 mmol/L, cardiac troponin I (cTnI) >0.7 μg/L, creatine kinase isoenzyme (CK-MB) >60 U/L, prothrombin time (PT) >15 s, blood urea nitrogen (BUN) >14 mmol/L and serum creatinine (SCr) >171 μmol/L were all independent risk factors of MODS in bee stings patients (P<0.05 or P<0.01).Conclusions Age, the duration from bee stings to hospitalization, WBC, Hb, serum K⁺, CO₂-CP, blood cTnI, CK-MB, PT, BUN, and SCr are all independent risk factors of MODS in bee stings patients.

蜂蜇伤致多器官功能障碍综合征的危险因素分析

The risk factors of multiple organ dysfunction syndrome caused by bee stings