野外與登山醫學-蜂螫毒性反應-中國湖北省案例分析 Clinical Features of Severe Wasp Sting Patients with Dominantly Toxic Reaction: Analysis of 1091 Cases

Clinical features of severe wasp sting patients with dominantly toxic reaction: analysis of 1091 cases 2013年中國湖北省蜂螫案1091例案例分析

死亡風險因子包過

1. 血清肌酸酐過高

2. 休克

3. 寡尿

4. 貧血
Regression analysis revealed that high creatinine level, shock, oliguria, and anemia were risk factors for death.

以毒性反應為主的重度黃蜂蜇傷患者1091例臨床特徵分析

摘要背景：大規模黃蜂螫傷事件被大大低估，尚未得到系統性研究。本研究的目的是確定嚴重黃蜂螫傷的臨床特徵和治療策略。方法與結果：在中國湖北省 35 家醫院和醫療中心（包括 12 家三級醫院和 23 家二級醫院）進行了一項多中心回顧性研究。對1091例黃蜂螫傷住院患者的詳細臨床資料進行了調查。超過四分之三（76.9%）的病例被螫傷 10 次或以上，患者院內死亡率為 5.1%。48 名患者因螫傷中毒反應死於器官損傷，6 名患者死於過敏性休克。蜇傷超過10 次的患者院內死亡率高於 10 次以下蜇傷患者的院內死亡率（5.2% vs. 1.1%）。0%，p = 0.02）。21.0%的患者出現急性腎損傷（AKI），大多數患者需要血液淨化治療。24.1%的患者出現橫紋肌溶解，19.2%的患者出現溶血，30.1%的患者出現肝損傷，22.5%的患者出現凝血功能障礙。迴歸分析顯示，高肌酸酐水平、休克、少尿和貧血是死亡的危險因子。血液淨化治療對被蜇傷 20 美元的患者和延遲入院的患者（蜇傷後 4 小時）有好處。

結論：在中國，大多數多次被黃蜂螫傷的患者表現為毒液引起的毒性反應和多重器官功能障礙，而不是過敏反應。AKI是黃蜂螫傷後出現中毒反應的突出臨床表現。高肌酸酐水平、休克、少尿和貧血是死亡的危險因子。p = 0.02）。21.0%的患者出現急性腎損傷（AKI），大多數患者需要血液淨化治療。24.1%的患者出現橫紋肌溶解，19.2%的患者出現溶血，30.1%的患者出現肝損傷，22.5%的患者出現凝血功能障礙。迴歸分析顯示，高肌酸酐水平、休克、少尿和貧血是死亡的危險因子。血液淨化治療對被蜇傷 20 處以上的患者和延遲入院的患者（蜇傷後 4 小時）有好處。

結論：在中國，大多數多次被黃蜂螫傷的患者表現為毒液引起的毒性反應和多重器官功能障礙，而不是過敏反應。

AKI是黃蜂螫傷後出現中毒反應的突出臨床表現。高肌酸酐水平、休克、少尿和貧血是死亡的危險因子。p = 0.02）。21.0%的患者出現急性腎損傷（AKI），大多數患者需要血液淨化治療。24.1%的患者出現橫紋肌溶解，19.2%的患者出現溶血，30.1%的患者出現肝損傷，22.5%的患者出現凝血功能障礙。迴歸分析顯示，高肌酸酐水平、休克、少尿和貧血是死亡的危險因子。血液淨化治療對被蜇傷 20 處以上的患者和延遲入院的患者（蜇傷後 4 小時）有好處。結論：在中國，大多數多次被黃蜂螫傷的患者表現為毒液引起的毒性反應和多重器官功能障礙，而不是過敏反應。AKI是黃蜂螫傷後出現中毒反應的突出臨床表現。高肌酸酐水平、休克、少尿和貧血是死亡的危險因子。

Abstract 

Background: 

Massive wasp stings have been greatly underestimated and have not been systematically studied. The aim of this study was to identify the clinical features and treatment strategies of severe wasp stings. 

Methods and Findings: 

A multicenter retrospective study was undertaken in 35 hospitals and medical centers including 12 tertiary care hospitals and 23 secondary care hospitals in the Hubei Province, China. The detailed clinical data of 1091 hospitalized wasp sting patients were investigated. Over three-fourths (76.9%) of the cases had 10 or more stings and the in-hospital mortality of patients was 5.1%. Forty-eight patients died of organ injury following toxic reactions to the stings, whereas six died from anaphylactic shock. The in-hospital mortality in patients with 10 stings was higher than that of 10 stings (5.2% vs. 1.0%, p = 0.02). Acute kidney injury (AKI) was seen in 21.0% patients and most patients required blood purification therapy. Rhabdomyolysis was seen in 24.1% patients, hemolysis in 19.2% patients, liver injury in 30.1% patients, and coagulopathy in 22.5% patients. Regression analysis revealed that high creatinine level, shock, oliguria, and anemia were risk factors for death. Blood purification therapy was beneficial for patients with 20 stings and delayed hospital admission of patients (4 hours after sting). Conclusions: In China, most patients with multiple wasp stings presented with toxic reactions and multiple organ dysfunction caused by the venom rather than an anaphylactic reaction. AKI is the prominent clinical manifestation of wasp stings with toxic reaction. High creatinine levels, shock, oliguria, and anemia were risk factors for death.