| Objective:Wasp stings have been reported worldwide,especially in the mountainous areas of developing countries in Asia.The Qinba Mountains in China are areas with frequent bee stings.Among them,wasp stings are the most common,which can affect multiple systems,leading to multiple organs dysfunction and even death.During clinical work,blood purification is often used for wasp stings’patients,but the efficacy of different blood purification treatments is not in consistent.This study intends to compare the clinical effects of different blood purification models on patients with multiple organs dysfunction caused by severe wasp stings,in order to provide a basis for the standardized therapy of severe wasp stings.Method:Through a retrospective study of 95 patients with severe wasp stings in Xijing Hospital,Shaanxi Provincial People’s Hospital and Hanzhong Central Hospital from January 2010 to December 2020,the patients were divided into 3 groups according to different blood purification modes:CVVH group:14 patients received continuous venous hemofiltration(CVVH)treatment;CVVH+HP group:39 patients received CVVH combined with HP treatment;CVVH+HP+IHD group:42 patients received CVVH+HP combined with IHD treatment.Collect the general information,clinical manifestations,blood biochemical indicators,time from sting to blood purification,blood purification treatment time,time taken for urine output to return to normal,pain disappearance time,dialysis-related adverse reactions,and hospitalization time of the enrolled patients.Acute Physiology and Chronic Health Status Score II(APACHE II Score)and Sequential Organ Failure Score(SOFA Score)evaluate the severity of the patient’s condition,observe the clinical efficacy,and follow up the discharged patients for at least 3 months to track the clinical outcome and hemodialysis For the treatment of disengagement,the statistical software SPSS23.0 was used for statistical analysis.Result:1.General clinical data:There was no significant difference in gender ratio,age distribution,main clinical symptoms and distribution of involved organs in the three groups before treatment(P>0.05);the number of bee stings in the CVVH+HP+IHD group was 30(20,50),more than the other two groups(P<0.05);in the CVVH+HP group,the time from sting to hospital admission was 12(9.5,17)hours,and the time from sting to the beginning of blood purification was 15.5(12,24)hours.It was longer than the other two groups(P<0.05);the SOFA score before treatment in the CVVH+HP+IHD group was 14.08±3.62,and the APACHEⅡscore was 27.78±3.84,which was higher than that in the CVVH group(P<0.05),and there was no significant difference between the remaining groups;2.The baseline level of blood biochemical indicators:The ALT and AST of the CVVH+HP group were 312.5(93.18,714.5)U/L and 1135(410.9,2641)U/L,respectively,and the ALT and AST of the CVVH+HP+IHD group were respectively 583(225,1150)and 1530.5(828.75,3689.25)U/L,higher than the CVVH group(P<0.05),there was no significant difference among the remaining groups;WBC,N,HB,HCT,PLT,TBIL,There was no statistical difference in ALP,CRE,UREA,UA,K+,Tn I,CK-MB,CK,BNP,MB,LDH,PT,APTT,LAC,PCT and IL-6(P>0.05);3.Main outcome indicators:The in-hospital mortality rates of CVVH,CVVH+HP and CVVH+HP+IHD groups were 21.43%,15.38%and 4.76%,respectively,and the 90-day renal survival rates were 69.23%,80%and 86.84%,respectively,90 The all-cause mortality rates were 23.08%,17.14%,and 5.26%,respectively.The in-hospital mortality rate in the CVVH+HP+IHD group was lower than that in the CVVH group(P<0.05),and there was no significant difference between the remaining groups(P>0.05);4.Changes in biochemical indicators:(1)After treatment for patients in CVVH,CVVH+HP and CVVH+HP+IHD groups:WBC(10~9/L)were 18.8±11.14,15.73±6.86 and 14.21±6.87,respectively,N(%)was 77.91±respectively 8.63,81.18±9.57 and 77.96±8.53,PCT(ng/ml)were 2.36±1.07,1.54±1.39 and 1.51±0.66,IL-6(pg/ml)were 114.83±60.97,69.9±34.03 and61.68,respectively±27.48,PT(s)were 14.23±2.12,13.13±1.43 and 14.56±2.67,APTT(s)were 54.26±21.03,51.63±29.14,and 48.47±23.24,and LAC(mmo/l)was 1.89±0.68,1.46±0.53,and 1.36±0.21,all decreased compared with the previous(P<0.05);PLT in the CVVH+HP and CVVH+HP+IHD groups were 146.47±75.3 and 152±78.07,respectively,which was higher than that in the CVVH group(P<0.05);HB(g/L)and HCT(%)in the CVVH+HP+IHD group were 119.13±19.06 and 38.65±6.7,respectively,which were higher than those of the other two groups(P<0.05);(2)The ALT drop rate after treatment in the three groups(%)Respectively:36.08(-153.73,72.42),75.45(20.66,84.84)and 87.67(67.81,94.2),AST reduction rate(%)are:34.14(-176.9,92.29),89.55(66.47,97.9)and97.95(93.53,98.89),TBIL reduction rate(%)were 43.24(8.82,75.94),70.95(46.45,82.29)and 80.26(66.05,87.11),UA reduction rate(%)were:24.71(6.12,56)),44.75(-1.47,67.61)and 51.1(22.64,67),the level of CRE increased by about 88.43%compared with the total before treatment,and the CVVH group increased by 105.08%,which was significantly higher than the 67.06%increase in the CVVH+HP group(P<0.05);5.Clinical situation:The SOFA scores of the three groups of patients after treatment were8.23±1.23,7.36±0.75 and 6.83±1.32,respectively,and the APACHEⅡscores were15.5±6.05,15.29±4.48 and 16.24±4.21,all of which were lower than before(P<0.05),and there was no significant difference between the groups(P>0.05);the time taken for the urine output of the three groups to return to normal was 4.31±1.06,3.34±0.35,and 8.46±4.08 days,respectively,and the average hospital stay was 18.27±4.75,20.55±,respectively 4.66 and23.26±8.94 days,CVVH+HP+IHD took longer than the other two groups(P<0.05);the sting pain disappearance time of the three groups was 4.5±0.84,4.9±1.02 and 5.6±0.68 days,respectively,and the three groups were continuous The blood purification treatment time was 26.5(24,43.5),36(24,56)and 36(26.5,58.25)hours respectively,and there was no significant difference between the groups(P>0.05);6.Adverse reactions:The incidences of adverse reactions in the three groups were 21.43%,20.51%and 23.81%,the proportions of pipeline coagulation were 21.43%,15.38%and13.95%,and the proportions of catheter-related infections were 0 and 5.13%,respectively.The rate of catheter-related infection in the CVVH+HP+IHD group was significantly higher than that in the CVVH group(P<0.05),and there was no significant difference between the other groups(P>0.05).Conclusion:CVVH,CVVH+HP and CVVH+HP+IHD have positive effects on organ support,inflammatory mediator removal,coagulation correction,and maintenance of internal environment stability of severe wasp stings.The three have a 90-day renal survival rate and a 90-day all-cause There is no significant difference in mortality,but CVVH+HP and CVVH+HP+IHD can lower ALT,AST,CK-MB,LDH and other liver enzymes and myocardial enzymes better than CVVH alone,and CVVH+HP+IHD The elimination of TBIL,CK,BNP and LAC is more significant,and the in-hospital mortality rate is lower than that of CVVH alone.Therefore,CVVH+HP+IHD is worthy of promotion in patients with significant heart,liver and kidney damage and critically ill wasp stings injuries. |
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