甲基强的松龙对重症蜂蜇伤患者的治疗分析

【摘要】 目的 探讨重症蜂蜇伤患者血清中肿瘤坏死因子α（TNF-α）、白细胞介素6（IL-6）、白细胞介素8（IL-8）的水平及甲基强的松龙冲击对其的影响。方法 将蜂蜇伤患者随机分为治疗组与对照组，2组均给予器官功能支持为主的综合治疗；治疗组前三天予以甲基强的松龙0.5g/d静脉滴注。分别于0h、2h观察2组患者的细胞因子（TNF-α，IL-6和IL-8）水平、2组患者入院0h、72h器官功能损害程度、并比较2组患者的死亡率。结果 0h时，治疗组、对照组TNF-α、IL-6和IL-8水平分别为3.21±0.84、113.25±35.61、162.49±79.33；3.17±0.79、109.83±32.58、157.71±73.65，二者比较无统计学差异（P＞0.05）；但在2h时TNF-α、IL-6、IL-8水平分别为8.11±2.34、37.95±11.68、53.99±25.86；15.67±5.21、314.76±86.40、452.07±211.09，存在统计学差异（P﹤0.05）；72h时，甲基强的松龙冲击治疗组患者器官功能损害程度明显低于对照组，存在显著的统计学差异（P﹤0.01或﹤0.05）；甲基强的松龙冲击治疗组患者治愈率明显高于对照组，存在统计学差异（P﹤0.05）. 结论 炎性细胞因子在引起蜂蜇伤患者多器官功能损害中起了重要作用, 甲基强的松龙冲击治疗可以明显减轻蜂蜇伤引起的这种损伤。甲基强的松龙冲击治疗可能降低蜂蜇伤急性期病死率,改善远期预后。

Clinical Observation of Large Dose of Methylprednisolone in Patient with Severe Wasp Sting

Objective: To investigate effects of methylprednisolone plus therapy on serum cytokine levels and organ function for severe bee stings. Methods: Sixty-nine patients with wasp sting were randomly divided into treatment group (n= 38) and control group (n=31). Patients were given organ support combined therapy in two groups. Methylprednisolone was given intravenous infusion of 0.5 g/d for the first three days in treatment group. The expression levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-8 were detected at 0 h and 2 h respectively in two groups. The changes of organ damage and the death rate were evaluated at 0 h, 72 h after admitted to hospital respectively. Results: The expression levels of TNF-α, IL-6 and IL-8 at 0 h were no significant differences between two groups (P > 0.05), but there was a significant difference at 2 h between two groups(P < 0.01). There was no significant difference in the organ damage at 0 h between two groups (P > 0.05). The organ damage was significantly lower at 72 h in treatment group than that of control group (P < 0.05). The recovery rate was significantly higher in treatment group (97.4%) than that of control group (83.9%,P < 0.05). Conclusion: Inflammatory cyto kines play an important role in the multiple organ dysfunction caused by wasp stings. Methylprednisolone pulse therapy can sig nificantly reduce the secondary damage caused by acute wasp sting, reduce the mortality and improve the long-term prognosis.