重症胡蜂蜇伤致溶血、多器官功能衰竭的成功救治体会

<正>蜂蜇伤是指蜜蜂、胡蜂(俗称马蜂,黄蜂)等蜇伤人体皮肤,导致疼痛、局部水肿等不适。重症蜂蜇伤,大量蜂毒进入血液循环,导致溶血、横纹肌溶解、肾衰竭、多器官功能衰竭(multiple organ dysfunction syndrom,MODS)而死亡~([1])。2015年10月,湖北民族大学附属恩施州中心医院成功救治2兄弟被同一     

蜂蜇伤研究进展

蜂毒成分较为复杂,蜂蛰伤可导致人体多脏器功能损害,表现为血管内溶血、横纹肌溶解、急性肾功能衰竭、肝脏损害、心脏损害、神经系统损害和DIC等,其中以肾脏损害最常见,心脏和肝脏次之。蜂蜇伤的发病机制与蜂毒素对人体的毒害作用及机体的过敏反应有关。蜂蜇伤目前尚无特异性治疗,死亡率较高。肾上腺素、糖皮质类固醇激素及血液净化等综合措施有一定疗效,免疫治疗对蜂毒过敏的患者是一项有效的治疗方法。     

连续性血液净化联合血浆置换治疗老年重症蜂蜇伤致多脏器功能衰竭患者的临床观察

<正>蜂蜇伤是临床常见急症之一,多发于山区,夏秋季较为常见,可引起过敏性休克、血管内溶血及多脏器功能衰竭等而危及生命,如抢救不及时,病死率较高。老年患者因多合并有基础疾病或者心肺功能较差,蜂蜇伤后更易死亡,血液净化和血浆置换(plasma exchange,PE)等综合治疗措施对其有较好疗效。笔者对我科2009年12月至2013年12月共25例重症蜂蜇伤老年患者的治疗情况进行回顾性分析,现报道如下。1资料与方法1.1一般资料收集我科2009年12月     

蜂蜇伤过敏性休克2例

蜂蜇伤后可致局部皮肤红肿痒痛，甚至引起过敏性休克、多脏器功能衰竭，但引起迟缓相I型变态反应过敏性休克的报道甚少，现将我院2例蜂蜇伤致迟缓型I型变态反应过敏性休克患者的救治体会报道如下。     

连续性血液净化治疗蜂蜇伤致多器官功能障碍综合征7例

野蜂蜇伤可引起局部疼痛、肿胀或过敏性休克，甚至可导致多脏器功能障碍综合征。我科于2002年7月～2005年7月采用连续性血液净化CBP（主要模式为CVVH）治疗7例蜂蜇伤致多器官功能障碍综合征（MODS）患者取得了良好疗效，现报告如下。     

季德胜蛇药联合TACE治疗中晚期肝癌的临床观察

目的观察季德胜蛇药联合肝动脉化疗栓塞（TACE）治疗中晚期肝癌的疗效。方法中晚期原发性肝癌28例,14例接受季德胜蛇药联合TACE治疗,14例只进行TACE。结果在治疗3月时,联合组肿瘤应答率为78.6%,明显高于对照组的57.1%（P〈0.05）,患者生活质量改善率分别为71.4%和50.0%（P〈0.05）。结论季德胜蛇药联合TACE治疗中晚期肝癌可提高疗效,可改善患者生活质量。     

蜂螫伤21例治疗及护理

蜂螫伤多发于山区,秋季较为常见。毒蜂尤其黄蜂螫伤可并发过敏性休克及多脏器功能损害,危及患者生命。蜂,属节肢体动物门,种类很多,有黄蜂、大黄蜂、胡蜂、土蜂、狮蜂、竹蜂、马蜂、蜜蜂等。蜂毒中主要含有蚁酸,神经毒,组织胺,激肽,5-羟色胺,透明质酸A、B,胆碱酯酶等。被蜂螫伤后可引起局部或全身反应,其中毒程度与蜂刺针数及个体差异和螯伤部位有关,应及时采取有效的急救治疗。本文通过对我科2006年10月至2008年12月收治的21例蜂螫伤患者的治疗回顾.     

蜂蜇致肾病综合征和膜性肾病一例

蜂毒的主要活性成分蜂毒素具有溶血、抗凝血和致敏作用.群蜂蜇伤后数天至数周常可并发多脏器损害,以肾脏、心脏和肝脏损害多见.蜂毒肾损伤可表现为急性肾小管坏死、少数为急性肾小管间质性肾炎[1];也可出现肾病综合征,病理以微小病变和系膜增生性肾炎为主[2-3],但膜性肾病未见报道,我院收治一例,现报道如下:     

血液灌流联合血液透析治疗毒蜂蜇伤中毒52例临床体会

毒蜂蜇伤是我市每年7至10月临床常见急诊之一,毒蜂蜂种均为大黄蜂（俗称葫芦蜂或马蜂）。曾有报道对蜂蜇伤者用血液透析治疗。我科自2006年7月至2008年11月共治重症蜂蜇伤患者52例,给予常规对症治疗和血液透析联合血液灌流治疗,疗效显著,现将治疗体会总结如下。     

蜂蜇伤致恶性室性心律失常并急性左室心力衰竭一例

患者男性,18岁。蜂蜇伤后送往我院急诊室心电图监护时突然出现室性心动过速、心室颤动。患者表现抽搐及呼吸停止,经电除颤、静脉推注利多卡因、多巴胺及入院后应用激素、强心及营养心肌治疗,6天后治愈出院。结论:蜂蜇伤后蜂毒损害心肌,可使心肌异位节律点兴奋性增强而呈现室性心律失常。     

Adverse effects of direct current cardioversion on cardiac pacemakers and electrodes Is external cardioversion contraindicated in patients with permanent pacing systems?

Use of pacing in sick sinus syndrome and recent developments in pacemaker therapy for intermittent atrial fibrillation raise the question of whether external electrical cardioversion should be used for termination of atrial fibrillation. This paper analyzes three cases of pacemaker and/or electrode dysfunction appearing after direct current (DC) cardioversion for termination of atrial fibrillation. Despite similar conditions during cardioversion in all cases, different dysfunctions reflecting damage to the pulse generator and/or a rise of the stimulation threshold in both, atrial and ventricular leads, have been observed. The possible mechanisms for these effects are discussed and recommendations for the management of cardioversion in patients with permanent pacemaker systems are given.     

Management strategies for gastrointestinal,erectile, bladder,and sudomotor dysfunction in patients with diabetes

There are substantial advances in understanding disordered gastrointestinal autonomic dysfunction in diabetes. It occurs frequently. The underlying pathogenesis is complex involving defects in multiple interacting cell types of the myenteric plexus as well. These defects may be irreversible or reversible. Gastrointestinal symptoms represent a major and generally underestimated source of morbidity for escalating health care costs in diabetes. Acute changes in glycaemia are both determinants and consequences of altered gastrointestinal motility. 35–90% of diabetic men have moderate‐to‐severe erectile dysfunction (ED). ED shares common risk factors with CVD. Diagnosis is based on medical/sexual history, including validated questionnaires. Physical examination and laboratory testing must be tailored to patient's complaints and risk factors. Treatment is based on PDE5‐inhibitors (PDE5‐I). Other explorations may be useful in patients who do not respond to PDE5‐I. Patients at high cardiovascular risk should be stabilized by their cardiologists before sexual activity is considered or ED treatment is recommended. Estimates on bladder dysfunction prevalence are 43–87% of type 1 and 25% of type 2 diabetic patients, respectively. Common symptoms include dysuria, frequency, urgency, nocturia and incomplete bladder emptying. Diagnosis should use validated questionnaire for lower urinary tract symptoms. The type of bladder dysfunction is readily characterized with complete urodynamic testing. Sudomotor dysfunction is a cause of dry skin and is associated with foot ulcerations. Sudomotor function can be assessed by thermoregulatory sweat testing, quantitative sudomotor axon reflex test, sympathetic skin response, quantitative direct/indirect axon reflex testing and the indicator plaster. Copyright © 2011 John Wiley & Sons, Ltd.     

围产期心肌病9例临床分析

目的:总结围产期心肌病的发病、危险因素、疗效及预后,为围产期心肌病的诊治提供循证医学证据。方法:入选2010年7月至2013年7月在我院心内科治疗的心肌病患者768例,其中围产期心肌病患者9例,回顾性分析其一般临床资料、发病率、危险因素、治疗效果及预后。结果:9例患者占单中心同期心肌病患者的1.2%(9/768),占40岁以下女性心肌病患者的31.0%(9/29)。年龄(27±4)岁。以双下肢水肿或腹水为主要表现的右心室功能不全者5例。超声示左心室收缩功能不全8例,胸片检查心胸比增大8例。患者常规接受抗心力衰竭、营养心肌等治疗,症状及体征好转后出院。随访12个月,8例患者左心室收缩功能均恢复。结论:围产期心肌病在40岁以下女性心肌病患者中发病率较高,以左心室功能不全为主要特征,超声心动图及胸片可评价患者心功能及有无心影增大,协助诊断。常规抗心力衰竭及营养心肌治疗有效,预后较好。     

咪达唑仑多次使用对小鼠学习记忆的影响

目的观察不同剂量的咪达唑仑多次使用对小鼠学习记忆的影响。方法100只KM小鼠分层随机区组设计,分为M1、M2、M3、M4组和生理盐水（NS）组,每组20只,各组再随机选取10只,参加跳台实验或避暗实验。M1、M2、M3和M4组分别以咪达唑仑0.5、1、2和4 mg/kg,NS组以10 ml/kg生理盐水腹腔注射,3次/d,连续10 d后,进行训练,24 h后进行记忆测验,以潜伏期和错误次数作为记忆成绩的指标。结果M1、M2、M3、M4组与NS组比较,M2、M3和M4组与M1组比较,M3和M4组与M2组比较,潜伏期缩短、错误次数次数增多（P〈0.05）;但M3组与M4组比较,潜伏期和错误次数相似（P〉0.05）。结论多次使用咪达唑仑对记忆的影响有一定剂量依赖性,但其记忆抑制作用有封顶效应。     

Syndrome of Nonobstructive Coronary Artery Diseases: A Comprehensive Overview of Open Artery Ischemia

Syndromes of cardiac ischemia with nonobstructive coronary arteries have been increasingly recognized as a clinical entity with heterogeneous clinical presentations, commonly encountered in women. Knowledge of pathophysiology and clinical risk factors is key to ensuring appropriate diagnostic evaluation and management for these often-neglected patients. In this review, we discuss the epidemiology, risk factors, and clinical presentations of these syndromes. We provide algorithms for diagnosis and management of these entities based on current scientific knowledge and highlight some of the key knowledge gaps and ongoing trials in this emerging field.     

三种微颗粒水平在糖尿病血管病变中的意义

Objective To investigate the levels of mieropartieles originated from platelet (PMP),endothelium (EMP),and tissue factor-bearing microparticles (TF+ MP) in diabetes mellitus and to analyze its relationship with diabetic angiopathy.Methods PMP,EMP or TF+ MP were measured in 106 cases of diabetes mellitus and 50 controls by flow eytometry.The differences of EMP between groups of diabetic macrovascular disease and diabetic microvascular disease were determined.Results The levels of EMP in diabetic patients were higher than that in the control(164.20±128.88 vs 63.81±40.84,P<0.05).Diabetic cases with complication showed higher expression level of EMP than those without complications(184.12±152.77,188.21±149.55 vs 138.53±99.87,both P<0.05).However,no distinct increase was observed in PMP and TF+ MP level in diabetes groups compared with control group.Conclusions Endothelial dysfunction,may contribute to the increased level of EMP in patients with diabetes,especially those complicated with vascular diseases.EMP level may be used to evaluate the status of endothelial function and the development of diabetic angiopathy.