胡蜂蛰伤致凝血功能障碍临床特征及其危险因素分析

发布时间：2018-05-27 03:43

本文选题：胡蜂蜇伤 + 凝血功能障碍　；参考：《遵义医学院》2017年硕士论文

【摘要】：目的:分析胡蜂蜇伤致凝血功能障碍患者的临床特点,为其诊断、治疗及预防提供依据。方法:回顾性分析2014.01~2016.12首诊于遵义医学院附属医院急诊科的181例胡蜂蜇伤住院患者,收集其一般信息及凝血、生化等实验室检查数据,并分析胡蜂蛰伤致凝血功能异常的发生率及临床特点,比较不同性别、不同入院时间APTT有无差异。将APTT异常者按治疗药物不同分为维生素K1组、血浆组及无特殊处理组,比较处理前后APTT水平。分别分析住院时间、APTT异常的相关影响因素。数据处理采用SPSS17.0软件包,比较差异用t检验或方差分析,相关性分析使用Spearman相关分析或逐步回归分析法。结果:胡蜂蛰伤好发于8~11月,常为头部、上肢等裸露部位受累,男患多于女患,尤以青壮年多见。凝血功能异常住院患者中多蜂蜇伤比例(96.38%)明显高于单蜂蛰伤,常伴随头昏、头痛与恶心、呕吐等症状。蜇伤后凝血异常发生率约76.24%,横纹肌、肝、心、肾等脏器亦不同程度受累。凝血异常以APTT延长为主要特点。将APTT异常者视为总体,不同性别APTT水平无明显差异(P0.05);蛰伤后1~6h入院者与总体及蜇伤后7~12h、12h就诊者相比,APTT水平明显偏低(P0.05);维生素K1、血浆组与无特殊处理组相比较,治疗前APTT值与治疗前后APTT差值均无明显差异(P0.05);Spearman相关分析表明器官损害数与住院时间存在正相关关系(r=0.503,P0.01);回归分析显示胡蜂蜇伤后APTT异常的危险因素为器官损害数、蜇伤致APTT达最高值时间,前者为正相关(b1=11.860,P0.01),后者为负相关(b2=-13.638,P0.05)。结论:胡蜂蜇伤后凝血功能异常发病率高,主要表现为APTT延长。受累器官数目多、蜇伤致APTT达最高值时间短是影响胡蜂蜇伤后APTT水平的主要危险因素。建议将早期APTT水平作为评估胡蜂蜇伤病情严重程度指标。
[Abstract]:Objective: to analyze the clinical features of coagulant dysfunction caused by wasp sting and to provide evidence for diagnosis, treatment and prevention. Methods: 181 cases of wasp stinging were first diagnosed in the emergency department of the affiliated Hospital of Zunyi Medical College on June 12, 2014.The general information, blood coagulation, biochemical data and other laboratory data were collected. The incidence and clinical characteristics of coagulant dysfunction caused by wasp stinging injury were analyzed, and the differences of APTT among different genders and admission time were compared. Patients with abnormal APTT were divided into vitamin K1 group, plasma group and no special treatment group according to the treatment drug. APTT levels were compared before and after treatment. The relative factors of abnormal APTT were analyzed. SPSS17.0 software package was used for data processing, t test or ANOVA was used to compare the differences, and Spearman correlation analysis or stepwise regression analysis was used for correlation analysis. Results: wasp stinging injury occurred from August to November. It was often involved in exposed parts such as head and upper extremities, more in males than females, especially in young adults. The proportion of multiple bee stings in patients with abnormal coagulation function (96.38) was significantly higher than that of single bee stings, and was often accompanied by dizziness, headache, nausea, vomiting and other symptoms. The incidence of abnormal coagulation after stinging was 76.24%, and the organs of striated muscle, liver, heart and kidney were also involved in varying degrees. APTT prolongation is the main feature of coagulation abnormality. The patients with abnormal APTT were considered as a whole, and there was no significant difference in the levels of APTT between different genders (P 0.05), the levels of APTT in patients admitted to hospital at 6 h after stinging were significantly lower than those in patients who were admitted to hospital at 1 h after stinging and those who were visited at 7 h and 12 h after stinging, the levels of APTT in vitamin K1, plasma group and no special treatment group were significantly lower than those in the group without special treatment. There was no significant difference between the APTT value before and after treatment and the difference of APTT before and after treatment. The correlation analysis showed that there was a positive correlation between the number of organ damage and the length of stay in hospital, and the regression analysis showed that the risk factor of abnormal APTT after wasp sting was organ damage. The time of reaching the maximum value of APTT after stinging injury was positive correlation between 11. 860 and P 0. 01, while that of the latter was negative correlation between b 2 and 13. 638 and P 0. 05 respectively. Conclusion: the incidence of abnormal coagulation function after wasp sting is high, mainly manifested by prolonged APTT. The high number of affected organs and the short time of APTT reaching maximum value were the main risk factors affecting the APTT level of wasp stings. It is suggested that early APTT level be used as an index to evaluate the severity of wasp sting.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R646

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