以血漿交換術治療合併嚴重併發症之蜂螫病例的臨床經驗－病例報告

膜翅目動物（Hymenoptera）如蜜蜂（bee），胡蜂（wasp），大黃蜂（hornet），yellow jacket、蟻類（ants）等之毒素在人體大多會引起過敏性反應，若嚴重者可導致過敏性休克，甚或併發嚴重毒性反應而導致死亡。一例11歲之女孩，在被一大群胡蜂（wasps）叮螫後24小時，呈現意識不清、急性腎衰竭、急性肝衰竭、肌溶解症、溶血性貧血、低血鈉及散播性血管內血液凝固症。住院後除給予各種支持性療法及血液成份輸血外，前後並施予5次密集式血漿交換術。此後病人意識恢復，肝腎機能改善，但肌溶解症及散播性血管內血液凝固症則持續進行，病兒不幸於住院4天後，併發嚴重肺出血而死亡。本文討論以血漿交換術治療後病兒之臨床變化及血漿交換術在治療這類病人上之應用。

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並列摘要

Stings of Hymenoptera insects(bee, wasp, hornet, yellow jacket, ants)can induce severe reactions, most of which are allergic and IgE-mediated. However, when hosts are stung by many insects simultaneously, severe toxic reactions can occur that may lead to shock or even death. An 11-year-old girl experienced severe toxic reactions after being stung by hundreds of wasps. After the initial minor anaphylactic shock, she experienced delayed acute renal failure, acute hepatic failure, rhabdomyolysis, hemolytic anemia, Hyponatremia, disseminated intravascular coagulation (DIC) and conscious disturbance. She was treated by anti-allergic therapy, blood components transfusions, and intensive plasma exchange therapy immediatedly after admission. She improved greatly in spirit and in restoration of hepatic and renal functions. Unfortunately, the symptoms caused by rhabdomyolysis and DIC persisted. However, the patient expired four days later due to severe pulmonary hemorrhage. The clinical course and the effect of plasma exchange were discussed in detail.

並列關鍵字

wasp stings ； biochemical intoxication ； plasma exchange

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以血漿交換術治療合併嚴重併發症之蜂螫病例的臨床經驗－病例報告

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