Effect Of Different Blood Purification Methods On MODS Caused By Wasp Sting

Objective:Blood purification is always used in combination with essential medicines for the patients suffered from multiple organ dysfunction syndrome after wasp stings.Yet there are no standards of blood purification due to the broad selectivity of blood purification ways.The purpose of this study is to identify patients suffered from visceral multiple organ dysfunction syndrome after wasp stings and to evaluate the effects of continuous veno-venous hemofiltration(CVVH)combined with plasma exchange(PE)or combined hemoperfusion(HP)on wasp stings.Look forward to providing more appropriate method of blood purification treatment program for multiple organ dysfunction syndrome caused by wasp stings for clinical treatment.Methods:A retrospective study was conducted on 45 severely ill patients with multiple organ dysfunction syndrome caused by brucellosis from the affiliated hospital of Zunyi Medical College from 2012 to 2017.Among them,18 patients received continuous intravenous-venous hemofiltration combined with plasma exchange,and the others received continuous venous-venous hemofiltration combined with hemoperfusion.Collected data of patient's age,gender,number of needles to be punctured,time of admission due to bruising,clinical symptoms,blood biochemical indicators,coagulation function,mechanical ventilation time,using of vasoactive drugs,hospitalization time and mortality.Acute physical and chronic health score II(APACHEII)and sequential organ failure assessment(SOFA)scoring systems were used for scoring.Results:There was no significant difference in the APACHE-II score,SOFA score,mean age,admission time,and number of needles between two groups before treatment(p>0.05).There was no significant difference in the proportions of circulatory failure,liver function damage,myocardial damage,renal injury,respiratory failure,disseminated intravascular coagulation(DIC),and hemolysis between the two groups of patients before treatment of blood purification(P>0.05).There was no significant difference in emographics,bruises and severity of illness between the two groups of patients before CVVH+PE or CVVH+HP.APACHE II score,SOFA score,levels of prothrombin time(PT),alanine aminotransferase(ALT),aspartate aminotransferase(AST),creatinine(Scr),CK-MB,TBI,DBI,IBI,and Mb decreased after treatment in patients with CVVH+PE(P<0.05).The levels of ALT,AST,CK-MB,Mb and SOFA scores in CVVH+PE group were significantly decreased compared with the CVVH+PE group(P<0.05).No significant difference was found in plasma interleukin-1(IL-1)and interleukin-6(IL-6)levels before or after treatment in both groups(P>0.05).The levels of interleukin-8(IL-8)and tumor necrosis factor(TNF-?)were significantly reduced after treatment,and this feature is more obvious in CVVH+PE group(P<0.05).The number of days of circulatory support,days of oliguria,days of hospital stay,and mechanical ventilation in the CVVH+PE group were also lower than those in the CVVH+HP group(P<0.05).Conclusion:Both HP + CVVH and PE +CVVH are effective to treatment for MODS secondary to multiple wasp stings,PE + CVVH was found to be significantly more effective in Myoglobin scavenging,Improvement of coagulation function,Mitigate organ damage and the lower complications.