本文選題：胡蜂蜇傷 + 凝血功能障礙　； 參考：《遵義醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:分析胡蜂蜇傷致凝血功能障礙患者的臨床特點(diǎn),為其診斷、治療及預(yù)防提供依據(jù)。方法:回顧性分析2014.01~2016.12首診于遵義醫(yī)學(xué)院附屬醫(yī)院急診科的181例胡蜂蜇傷住院患者,收集其一般信息及凝血、生化等實(shí)驗(yàn)室檢查數(shù)據(jù),并分析胡蜂蟄傷致凝血功能異常的發(fā)生率及臨床特點(diǎn),比較不同性別、不同入院時(shí)間APTT有無(wú)差異。將APTT異常者按治療藥物不同分為維生素K1組、血漿組及無(wú)特殊處理組,比較處理前后APTT水平。分別分析住院時(shí)間、APTT異常的相關(guān)影響因素。數(shù)據(jù)處理采用SPSS17.0軟件包,比較差異用t檢驗(yàn)或方差分析,相關(guān)性分析使用Spearman相關(guān)分析或逐步回歸分析法。結(jié)果:胡蜂蟄傷好發(fā)于8~11月,常為頭部、上肢等裸露部位受累,男患多于女患,尤以青壯年多見(jiàn)。凝血功能異常住院患者中多蜂蜇傷比例(96.38%)明顯高于單蜂蟄傷,常伴隨頭昏、頭痛與惡心、嘔吐等癥狀。蜇傷后凝血異常發(fā)生率約76.24%,橫紋肌、肝、心、腎等臟器亦不同程度受累。凝血異常以APTT延長(zhǎng)為主要特點(diǎn)。將APTT異常者視為總體,不同性別APTT水平無(wú)明顯差異(P0.05);蟄傷后1~6h入院者與總體及蜇傷后7~12h、12h就診者相比,APTT水平明顯偏低(P0.05);維生素K1、血漿組與無(wú)特殊處理組相比較,治療前APTT值與治療前后APTT差值均無(wú)明顯差異(P0.05);Spearman相關(guān)分析表明器官損害數(shù)與住院時(shí)間存在正相關(guān)關(guān)系(r=0.503,P0.01);回歸分析顯示胡蜂蜇傷后APTT異常的危險(xiǎn)因素為器官損害數(shù)、蜇傷致APTT達(dá)最高值時(shí)間,前者為正相關(guān)(b1=11.860,P0.01),后者為負(fù)相關(guān)(b2=-13.638,P0.05)。結(jié)論:胡蜂蜇傷后凝血功能異常發(fā)病率高,主要表現(xiàn)為APTT延長(zhǎng)。受累器官數(shù)目多、蜇傷致APTT達(dá)最高值時(shí)間短是影響胡蜂蜇傷后APTT水平的主要危險(xiǎn)因素。建議將早期APTT水平作為評(píng)估胡蜂蜇傷病情嚴(yán)重程度指標(biāo)。
[Abstract]:Objective: to analyze the clinical features of coagulant dysfunction caused by wasp sting and to provide evidence for diagnosis, treatment and prevention. Methods: 181 cases of wasp stinging were first diagnosed in the emergency department of the affiliated Hospital of Zunyi Medical College on June 12, 2014.The general information, blood coagulation, biochemical data and other laboratory data were collected. The incidence and clinical characteristics of coagulant dysfunction caused by wasp stinging injury were analyzed, and the differences of APTT among different genders and admission time were compared. Patients with abnormal APTT were divided into vitamin K1 group, plasma group and no special treatment group according to the treatment drug. APTT levels were compared before and after treatment. The relative factors of abnormal APTT were analyzed. SPSS17.0 software package was used for data processing, t test or ANOVA was used to compare the differences, and Spearman correlation analysis or stepwise regression analysis was used for correlation analysis. Results: wasp stinging injury occurred from August to November. It was often involved in exposed parts such as head and upper extremities, more in males than females, especially in young adults. The proportion of multiple bee stings in patients with abnormal coagulation function (96.38) was significantly higher than that of single bee stings, and was often accompanied by dizziness, headache, nausea, vomiting and other symptoms. The incidence of abnormal coagulation after stinging was 76.24%, and the organs of striated muscle, liver, heart and kidney were also involved in varying degrees. APTT prolongation is the main feature of coagulation abnormality. The patients with abnormal APTT were considered as a whole, and there was no significant difference in the levels of APTT between different genders (P 0.05), the levels of APTT in patients admitted to hospital at 6 h after stinging were significantly lower than those in patients who were admitted to hospital at 1 h after stinging and those who were visited at 7 h and 12 h after stinging, the levels of APTT in vitamin K1, plasma group and no special treatment group were significantly lower than those in the group without special treatment. There was no significant difference between the APTT value before and after treatment and the difference of APTT before and after treatment. The correlation analysis showed that there was a positive correlation between the number of organ damage and the length of stay in hospital, and the regression analysis showed that the risk factor of abnormal APTT after wasp sting was organ damage. The time of reaching the maximum value of APTT after stinging injury was positive correlation between 11. 860 and P 0. 01, while that of the latter was negative correlation between b 2 and 13. 638 and P 0. 05 respectively. Conclusion: the incidence of abnormal coagulation function after wasp sting is high, mainly manifested by prolonged APTT. The high number of affected organs and the short time of APTT reaching maximum value were the main risk factors affecting the APTT level of wasp stings. It is suggested that early APTT level be used as an index to evaluate the severity of wasp sting.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R646

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