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蜂蛰伤患者发生多器官功能障碍综合征的危险因素分析

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目的:探讨蜂蛰伤患者发生多器官功能障碍综合征(MODS)的危险因素。方法:回顾性分析2015年1月至2021年12月在广西玉林市第一人民医院住院治疗的蜂蛰伤患者,按是否出现MODS分为MODS组(27例)和非MODS组(84例),研究2组临床资料的差异,使用Logistic回归分析MODS的危险因素,并ROC曲线分析相关危险因素的最佳截点。结果:纳入111例蜂蛰伤病例中MODS的发生率为24.3%,MODS组的年龄、损害时长、住院天数、住院后气管插管率、急性肾损伤发生率、血尿发生率、蛋白尿发生率、直接胆红素、脂肪酶、脂肪酶升高比例、血肌酐、高敏肌钙蛋白T、血浆凝血酶原时间和活化部分凝血酶原时间均高于非MODS组,而血清白蛋白和凝血酶原时间活动度低于非MODS组(均P<0.05)。Logistic回归分析提示:出现蛋白尿、血清白蛋白下降和脂肪酶升高是蜂蛰伤患者发生MODS的独立危险因素;出现蛋白尿的蜂蛰伤患者发生MODS的风险,是无蛋白尿蜂蛰伤患者的21.125倍;脂肪酶升高的蜂蛰伤患者发生MODS的风险,是脂肪酶正常蜂蛰伤患者的7.033倍。Logistic回归模型结合ROC曲线分析提示:血清白蛋白水平<37.05 g/L的蜂蛰伤患者发生MODS的风险,为血清白蛋白水平≥37.05 g/L患者的25.9倍(P<0.001)。结论:蜂蛰伤患者如出现蛋白尿、脂肪酶升高和血清白蛋白水平<37.05 g/L,出现MODS的风险明显升高,需早期积极防治。
Risk factors for multiple organ dysfunction syndrome in patients with bee sting injury
Objective:To identify the risk factors for the occurrence of multiple organ dysfunction syndrome (MODS) in patients with bee sting injury.Methods:A retrospective analysis was conducted on patients with bee sting injury who were hospitalized at the First People' s Hospital of Yulin City, Guangxi from January 2015 to December 2020. The patients were divided into either an MODS group (27 cases) or a non-MODS group (84 cases) based on the presence or absence of MODS. The differences in clinical data between the two groups were compared. Logistic regression analysis was used to identify the risk factors for MODS, and the optimal cutoff points for relevant risk factors were analyzed using ROC curves.Results:Among the 111 cases of bee sting injury included, the incidence of MODS was 24.3%. In the MODS group, the age, duration of injury, length of hospital stay, rate of endotracheal intubation after hospitalization, occurrence rate of acute kidney injury, hematuria, and proteinuria, direct bilirubin, lipase, rate of elevated lipase, blood creatinine, high-sensitivity cardiac troponin T, plasma prothrombin time, and activated partial thromboplastin time were higher than those in the non-MODS group, while serum albumin and coagulation factor activity were lower (P<0.05 for all). Logistic regression analysis indicated that the independent risk factors for MODS in patients with bee sting injury were the presence of proteinuria, decrease in serum albumin, and elevation of lipase. The risk of MODS in patients with proteinuria was 21.125 times that of patients without, and the risk of MODS in patients with elevated lipase was 7.033 times that of patients with normal lipase. The logistic regression model combined with ROC curve analysis suggested that the risk of MODS in patients with bee sting injury with a serum albumin level < 37.05 g/L was 25.9 times higher than that of patients with a serum albumin level ≥ 37.05 g/L (P<0.001).Conclusion:Patients with bee sting injury who present with proteinuria, elevated lipase, and serum albumin level <37.05 g/L have a significantly increased risk of developing MODS and require early and proactive prevention and treatment.

陆猛桂、黄斌、李秋林、何媛梅

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537000 广西玉林,玉林市第一人民医院肾内科

537000 广西玉林,玉林市第一人民医院急诊科

蜂蜇伤 多器官功能障碍综合征 危险因素

2023

中华临床医师杂志(电子版)
中华医学会

中华临床医师杂志(电子版)

CSTPCD
影响因子:0.99
ISSN:1674-0785
年,卷(期):2023.17(9)
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