胡蜂蜇伤患者全身炎症反应综合征临床特点及其对预后的影响

Clinical characteristics of systemic inflammatory response syndrome in patients with wasp stings and its effect on prognosis

关键词: 胡蜂蜇伤  全身炎症反应综合征(SIRS)  预后

Keywords: wasp sting  systemic inflammatory response syndrome (SIRS)  prognosis

摘 要: 目的 分析胡蜂蜇伤患者并发全身炎症反应综合征(SIRS)的临床特征及其对预后的影响。方法 采用回顾性病例对照研究,选取 2014—2023 年汉中市中心医院收治的 393 例胡蜂蜇伤患者为研究对象,其中 SIRS 组 117 例、非 SIRS 组 276 例; 单因素分析采用 t 检验、Mann-Whitney U 检验、χ² 检验或精确 F 检验,多因素 logistic 回归分析胡蜂蜇伤患者发生 SIRS 的危险因素。结果 393 例蜂蜇伤患者中发生 SIRS 117 例,占 29.78%;在 SIRS 的 4 项构成因素中,以 WBC 升高最常见,其次为呼吸和心率加快,未见体温异常因素。单因素分析显示蜂蜇伤创面≥10 处、皮肤溃疡、消化及呼吸系统出现过敏反应在 SIRS 组和非 SIRS 组间的差异具有统计学意义( P<0.05);蜂蜇伤创面≥10 处、呼吸系统过敏反应是导致蜂蜇伤并发 SIRS 的独立危险因素;SIRS 组患者死亡率(16.24%,19/117)、多器官功能障碍综合征(MODS)发生率(26.50%,31/117)均显著高于非 SIRS 组(2.90%,10.87%); 两组在急性脏器功能损伤相关指标间的差异亦具有统计学意义( P<0.05)。 结论 SIRS 在胡蜂蜇伤患者中发生比例较高,对患者预后具有不利影响;蜂蜇伤创面数量和出现呼吸系统过敏反应是导致蜂蜇伤患者 SIRS 的独立危险因素。

Abstract: Objective To analyze the clinical characteristics of systemic inflammatory response syndrome (SIRS) in patients with wasp stings and its impact on prognosis.Methods A retrospective case-control study was conducted,selecting 393 patients with wasp stings admitted to Hanzhong Central Hospital from 2014 to 2023 as research subjects,including 117 in the SIRS group and 276 in the non-SIRS group.Univariate analysis was performed using t-test,Mann-Whitney U test,chi-square test or exact F-test,and the multivariate logistic regression was used to analyze the risk factors for SIRS in patients with wasp stings.Results The results showed that among the 393 wasp stung patients,there were 117 cases of SIRS,accounting for 29.78%;among the four components of SIRS, elevated leukocytes was the most common, followed by increased breathing and heart rate,but no abnormal body temperature was observed.In the univariate analysis,there were some statistically significant differences between SIRS group and non-SIRS group in terms of sting wounds ≥10,skin ulcers,and allergic reactions in digestive and respiratory systems;sting wounds ≥10 and allergic reaction of respiratory system were the independent risk factors for bee sting induced SIRS.Furthermore,the mortality rate (16.24%,19/117) and the incidence of multiple organ dysfunction syndrome (MODS) in SIRS group were significantly higher than those in non SIRS group (2.90%,10.87%),and the difference in indicators related to acute organ dysfunction between the two groups was also statistically significant (P<0.05).Conclusion This study suggested that SIRS had a high incidence rate in wasp stung patients, which had obviously negative impact on prognosis of the patients; meanwhile,the number of wounds and occurrence of respiratory allergic reaction were the independent risk factors for SIRS in patients with wasp stings.