本文選題：蜂蜇傷　切入點(diǎn)：急性腎損傷　出處：《瀘州醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的：研究蜂蜇傷致急性腎損傷(AKI)的危險(xiǎn)因素及影響蜂蜇傷致AKI患者預(yù)后的相關(guān)因素,為臨床提供相關(guān)依據(jù),從而更有效地提高蜂蜇傷致急性腎損傷患者的救治成功率。方法：采用回顧性調(diào)查方法,收集2003年9月-2013年9月瀘州醫(yī)學(xué)院附屬醫(yī)院收治蜂蜇傷患者的臨床資料。根據(jù)研究需要設(shè)計(jì)《蜂蜇傷患者臨床資料記錄表》,用統(tǒng)一的記錄表收集蜂蜇傷患者原始病歷資料的相關(guān)內(nèi)容,主要內(nèi)容包括：性別、年齡、蜂蜇傷到入院時(shí)間間隔、總住院天數(shù)、單蜂/群蜂蜇傷、臨床表現(xiàn)、入院后第一個(gè)24小時(shí)序貫性器官衰竭評(píng)估(SOFA)評(píng)分和輔助檢查(包括血常規(guī)、電解質(zhì)、肝功、腎功、血脂、心肌損傷標(biāo)記物、凝血功能)、治療情況、預(yù)后情況,建立數(shù)據(jù)庫,數(shù)據(jù)采用SPSS17.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)處理。結(jié)果：1.蜂蜇傷患者一般情況：2003年9月-2013年9月瀘州醫(yī)學(xué)院附屬醫(yī)院收治的蜂蜇傷患者共150例,符合納入標(biāo)準(zhǔn)有91例,其中女性34例,男性57例,患者年齡的中位數(shù)及四分位數(shù)間距為39(12,58)歲,蜂蜇傷入院患者例數(shù)呈逐漸增高趨勢,而蜂蜇傷死亡率呈下降趨勢。2.蜂蜇傷患者發(fā)生MODS、AKI情況：(1) MODS患者累及器官情況：91例蜂蜇傷患者中發(fā)生MODS患者23例,累及器官依次為：肝臟23例、腎臟19例、凝血系統(tǒng)12例、循環(huán)系統(tǒng)6例、呼吸系統(tǒng)6例。(2)AKI患者伴MODS'情況：91例蜂蜇傷患者中蜂蜇傷患者中發(fā)生AKI共21例患者,伴MODS患者19例(90.5%),無MODS患者2例(9.5%)。(3)患者AKI、MODS與預(yù)后情況：AKI伴MODS患者19例,痊愈8例,死亡11例；AKI不伴MODS患者2例,痊愈1例,死亡1例；MODS不伴AKI患者4例,痊愈3例,死亡1例；無AKI無MODS66例,痊愈65例,死亡1例。(4)AKI伴MODS患者器官衰竭數(shù)與預(yù)后情況：AKd伴MODS患者19例：2個(gè)器官功能衰竭3例,痊愈2例,死亡1例；3個(gè)器官衰竭13例,痊愈6例,死亡7例；4個(gè)器官衰竭3例,均死亡。3.蜂蜇傷致AKI組和非AKI組患者情況比較：(1)一般情況比較：蜂蜇傷致AKI組與非AKI組患者性別情況無統(tǒng)計(jì)學(xué)差異。AKI組患者年齡中位數(shù)及四分位數(shù)間距為48.5(34.8,65.3)歲,非AKI組為38.5(12.0,52.0)歲,二者比較有統(tǒng)計(jì)學(xué)差異(P0.05)；AKI組蜂蜇傷到入院時(shí)間間隔的中位數(shù)及四分位數(shù)間距為24(10,84)小時(shí),非AKI組為5(3,9)小時(shí),兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.001)；AKI組患者住院時(shí)間中位數(shù)及四分位數(shù)間距為7.5(2.3,17.5)天,非AKI組為3(2,5)天,兩組的住院時(shí)間差異有統(tǒng)計(jì)學(xué)意義(P0.05)；AKI組患者死亡率為57.1%；非AKI組為2.9%,兩組比較P0.01,差異有統(tǒng)計(jì)學(xué)意義。(2)MODS'情況比較AKI組患者M(jìn)ODS發(fā)生率為90.5%；非AKI組為5.7%；兩組的MODS發(fā)生率比較P0.001,兩組差異有統(tǒng)計(jì)學(xué)意義；AKI組MODS患者SOFA平均分為7.9±2.5分,非急性腎損傷組為3.3士1.5分,兩組比較P0.05,兩組MODS患者SOFA平均分差異有統(tǒng)計(jì)學(xué)意義。(3)輔助檢查結(jié)果比較：AKI組和非AKI組患者入院后第一個(gè)24小時(shí)白細(xì)胞計(jì)數(shù)(WBC)、血紅蛋白(HB)、鉀(K+)、二氧化碳結(jié)合力(CO2)、尿素(UREA)、肌酐(CRE)、谷丙轉(zhuǎn)氨酶(ALT)、谷草轉(zhuǎn)氨酶(AST)、總膽紅素(TBIL)、總膽固醇(TC)、甘油三酯(TG)、超敏肌鈣蛋白I (TnI-U1)、肌酸激酶MB亞型(CK-MB)、凝血酶原時(shí)間(PT)、活化部分凝血酶時(shí)間(APTT)比較(P0.05),差異均有統(tǒng)計(jì)學(xué)意義。(4)多因素Logistic回歸分析：結(jié)果顯示蜂蜇傷患者年齡55歲、蜂蜇傷到入院時(shí)間≥6小時(shí)、白細(xì)胞計(jì)數(shù)20×109/L、貧血是蜂蜇傷后發(fā)生AKI的獨(dú)立危險(xiǎn)因素(P0.05)。4.蜂蜇傷致AKI痊愈組和死亡組患者情況分析：(1)一般情況：AKI痊愈組患者平均年齡為30.1±20.6歲,死亡組患者為56.1士18.6歲；AKI痊愈組患者蜂蜇傷到入院時(shí)間間隔的中位數(shù)和四分位數(shù)間距為11.0(5.5,36.8)小時(shí),死亡組為36.0(20.0,144.0)小時(shí)；急性腎損傷痊愈組患者住院天數(shù)的中位數(shù)和四分位數(shù)間距為16.0(10.5,23.5)天,死亡組為3.0(1.0,5.0)天。(2) MODS'隋況：AKI痊愈組MODS發(fā)生率為88.9%,AKI死亡組MODS發(fā)生率為91.7%；AKI痊愈組患者SOFA平均分為6.2士1.9分,死亡組為9.2±2.3分。(3)輔助檢查結(jié)果：AKI痊愈組和死亡組入院后第一個(gè)24小時(shí)WBC、 HB、K+、CO2、UREA、CRE、ALT、AST、TBIL、TC、G、TnI-U1、 CK-MB、PT、APTT均明顯異常。結(jié)論：1.蜂蜇傷患者年齡55歲、蜂蜇傷到入院時(shí)間≥6小時(shí)、白細(xì)胞計(jì)數(shù)20×109/L、貧血是蜂蜇傷后發(fā)生急性腎損傷的獨(dú)立危險(xiǎn)因素。2.年齡、就診時(shí)間、MODS衰竭器官數(shù)量、SOFA評(píng)分高低可能是蜂蜇傷致AKI患者預(yù)后不良的因素。
[Abstract]:Objective: To study the acute renal injury induced by bee sting (AKI) risk factors and prognostic factors of patients with AKI caused by bee stings, and to provide evidence for clinical, so as to more effectively improve the bee sting treatment in patients with acute renal injury induced by the success rate. Methods: a retrospective survey methods, September 2003 in September -2013 admitted to Affiliated Hospital of Luzhou Medical College from bee stings in patients with clinical data. Based on the design of < bee stings in patients with clinical data record >, with a unified collection of records related content of bee stings in patients with original medical records, the main contents include: gender, age, bee sting to admission time interval, total hospital stay single, bee bee stings, clinical manifestations, the first 24 hours after admission sequential organ failure assessment (SOFA) score and auxiliary examination (including blood routine, liver function, renal function, electrolyte, blood lipids, myocardial injury markers Material, treatment, coagulation function), prognosis, database, data using SPSS17.0 statistical software. Results: 1. patients with bee sting in general: September 2003 -2013 year in September admitted to the Affiliated Hospital of Luzhou Medical College from bee sting patients in 150 cases, compliance with the inclusion criteria of 91 cases, there were 34 female and 57 male cases. The median age of the patients and the four percentile interval was 39 (12,58), the number of patients with bee sting was gradually increased, while the bee sting mortality decline.2. bee stings in patients with MODS, AKI (1): MODS patients with organ involvement: 91 cases of patients with bee sting in 23 MODS patients, the involved organs were: 23 cases of liver and kidney in 19 cases, 12 cases of 6 cases of blood coagulation system, circulatory system, respiratory system. 6 cases (2) of MODS'AKI patients: 91 cases of patients with bee sting bee stings occur in patients with a total of 21 cases of AKI 鎮(zhèn)ｈ，

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