Wei Tingqiu, Liao Huafeng, Xiao Junxin, Zeng Dezhi, Chen Shaowu, Ju Hao, Wang Hua, Feng Wencong, Huang Jiazheng
Department of Intensive Care Unit, Liuzhou Traditional Chinese Medical Hospital, Liuzhou 545006, Guangxi Zhuang Autonomous Region, China.
Department of Intensive Care Unit, Guilin Municipal Hospital of Traditional Chinese Medicine, Guilin 541000, Guangxi Zhuang Autonomous Region, China.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2023 Mar;35(3):263-268. doi: 10.3760/cma.j.cn121430-20221116-01001.
To compare the effect and safety of continuous veno-venous hemofiltration (CVVH)+double plasma molecular absorption (DPMA)+hemoperfusion (HP), CVVH+HP, and CVVH+plasma exchange (PE) in treatment of patient with severe wasp stings injury.
Multicenter, historical cohort study and superiority test were used. From July 2020 to October 2022, patients with wasp sting injury and multiple organ damage admitted to the intensive care units (ICU) of five hospitals were consecutively screened and recruited into the CVVH+DPMA+HP group (intervention group). Propensity score matching was used to establish historical cohorts. Patients with severe wasp sting injury who hospitalized from January 2016 to June 2020 in each ICU were collected and matched 1:1 with the intervention group, and divided into CVVH+HP group and CVVH+PE group according to their actual hemopurification protocols (historical control groups). The primary outcome was the acute physiology and chronic health evaluation II (APACHE II) score on days 3 and 7 after initiation of treatment. Secondary outcomes included complications, length of ICU and hospital stays, and all-cause mortality. Multivariate Cox proportional risk regression was used to analyze the prognosis of patients.
After propensity score matching, 56 patients in intervention group and each of the two historical control groups were matched successfully. There were no significant differences in age, gender, comorbidities, biochemical test indices and critical illness scores among the groups. After treatment, APACHE II score markedly declined in all groups, and the decrease was faster in the intervention group; treatment with DPMA [hazard ratio (HR) = 1.04, 95% confidence interval (95%CI) was 1.02-1.08, P = 0.00], the decreased levels of body temperature (HR = 1.02, 95%CI was 1.00-1.03, P = 0.02), serum creatine kinase (CK; HR = 0.98, 95%CI was 0.96-1.00, P = 0.05) and myoglobin (MYO; HR = 2.88, 95%CI was 1.24-6.69, P = 0.01) were independent risk factors for APACHE II score decline to the target value (15 scores). There were no significant differences in the incidence of bleeding complications, filter or perfusion thrombosis, blood pressure reduction, catheter-related infection and anaphylaxis among the groups.
CVVH+DPMA+HP regimen can significantly reduce the APACHE II score of patients with severe wasp sting injury, and the efficacy is superior to CVVH+HP and CVVH+PE regimens, with safety.
比较持续静静脉血液滤过（CVVH）+双重血浆分子吸附（DPMA）+血液灌流（HP）、CVVH+HP以及CVVH+血浆置换（PE）治疗重度黄蜂蜇伤患者的疗效及安全性。
采用多中心、历史性队列研究及优效性检验。2020年7月至2022年10月，连续筛选入住5家医院重症监护病房（ICU）的黄蜂蜇伤合并多器官损害患者，纳入CVVH+DPMA+HP组（干预组）。采用倾向评分匹配法建立历史性队列。收集各ICU 2016年1月至2020年6月住院的重度黄蜂蜇伤患者，并与干预组1:1匹配，根据其实际血液净化方案分为CVVH+HP组和CVVH+PE组（历史性对照组）。主要结局为治疗开始后第3天和第7天的急性生理与慢性健康状况评分II（APACHE II）。次要结局包括并发症、ICU住院时间和住院时间以及全因死亡率。采用多变量Cox比例风险回归分析患者的预后。
倾向评分匹配后，干预组与两个历史性对照组各56例患者成功匹配。各组间年龄、性别、合并症、生化检验指标及危重病评分无显著差异。治疗后，所有组的APACHE II评分均显著下降，且干预组下降更快；使用DPMA治疗[风险比（HR）=1.04，95%置信区间（95%CI）为1.02-1.08，P = 0.00]、体温下降水平（HR = 1.02，95%CI为1.00-1.03，P = 0.02）、血清肌酸激酶（CK；HR = 0.98，95%CI为0.96-1.00，P = 0.05）和肌红蛋白（MYO；HR = 2.88，95%CI为1.24-6.69，P = 0.01）是APACHE II评分降至目标值（15分）的独立危险因素。各组间出血并发症、滤器或灌流血栓形成、血压降低、导管相关感染及过敏反应的发生率无显著差异。
CVVH+DPMA+HP方案可显著降低重度黄蜂蜇伤患者的APACHE II评分，疗效优于CVVH+HP和CVVH+PE方案，且安全性良好。
