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目的:观察肾上腺素联合甲泼尼龙及血液净化疗法对危重胡蜂蛰伤患者的治疗作用,探索减轻患者脏器损害,改善患者预后的优选治疗方案。方法:将45例危重胡蜂蜇伤患者随机分为对照组和观察组。在血液净化和对症处理的基础上,对照组用5%葡萄糖注射液250ml加甲泼尼龙80mg静脉注射,酱油色尿者用甲泼尼龙0.5g静脉注射连续3～5d;观察组在此基础上立即皮下注射0.1%肾上腺素0.5ml,头部剧痛、解酱油色尿者3～4h重复使用。结果:患者外周血白细胞水平普遍升高,升高幅度与蜂蜇针眼数、CKMB、ALT水平以及住院时间成正相关(相关系数分别为r=0.733,P<0.01;r=0.627,P<0.01;r=0.705,P<0.01;r=0.667,P<0.01;)与Scr的水平无明显相关性(r=0.205,P>0.05)。观察组谷丙转氨酶(ALT)及肌酸激酶同工酶(CKMB)明显低于对照组,(64.05±59.31v/s124.14±80.01U/L,P<0.001);(90.32±85.19v/s216.68±277.58μmol/L,P<0.05);平均住院时间(d)短于对照组,(7.23±2.93v/s11.23±8.02,P<0.05);观察组蜂蛰伤并发症除蛋白尿外,明显少于对照组(P<0.05);结论:蜂蛰伤的发病过程除了蜂毒对人体的直接作用外,变态反应及炎性反应扮演了重要角色。与单用糖皮质激素比较,及早联合使用肾上腺素治疗,有利于进一步抑制变态反应和炎性介质的扩散,减轻患者的病情,改善预后。
OBJECTIVE: To observe the therapeutic effect of epinephrine combined with methylprednisolone and blood purification therapy on the critically endangered wasps, and to explore the optimal treatment plan to reduce the organ damage and improve the prognosis of patients. Methods: Forty-five critically injured wasps were randomly divided into control group and observation group. On the basis of blood purification and symptomatic treatment, the control group was intravenously injected with 250 ml of 5% glucose injection and 80 mg of methylprednisolone, while the soy sauce and color urine were intravenously injected with 0.5 g of methylprednisolone for 3 to 5 days continuously. On the basis of this observation group Immediately subcutaneous injection of 0.1% epinephrine 0.5ml, head pain, solution of soy sauce color 3 ~ 4h repeated use. Results: The level of leukocyte in peripheral blood of patients was generally higher than that of control group (P <0.01). There was a positive correlation between the level of leukopenia and the number of eye of bee sting, CKMB, ALT and hospital stay (r = 0.733, r = 0.705, P <0.01; r = 0.667, P <0.01). There was no significant correlation between the level of Scr and the level of Scr (r = 0.205, P> 0.05). The levels of ALT and CKMB in the observation group were significantly lower than those in the control group (64.05 ± 59.31v / s124.14 ± 80.01U / L, P <0.001); (90.32 ± 85.19v / s216.68 ± 277.58μmol / L, P <0.05). The average length of hospital stay (d) was shorter than that of the control group (7.23 ± 2.93v / s11.23 ± 8.02, P <0.05) (P <0.05). Conclusion: In addition to the direct effect of bee venom on the human body, the allergic reaction and inflammatory reaction play an important role in the pathogenesis of bee stings. Compared with glucocorticoid alone, the combination of adrenaline and early treatment is conducive to further inhibit the proliferation of allergic reactions and inflammatory mediators, reduce the patient’s condition and improve prognosis.