摘要
目的探讨重症中暑患者的临床特征及热射病的早期敏感指标,以期对重症中暑患者病情发展进行早期预测。方法选择2018年7月30日至8月5日北京市大兴区人民医院急诊科收治的38例重症中暑患者为研究对象,其中热射病患者30例,包括劳力型热射病(EHS)18例、经典型热射病(CHS)12例;热痉挛与热衰竭患者8例,作为对照组。记录患者的性别、年龄、发病时间,入院时的体温、心率(HR)、血乳酸(Lac)、血小板计数(PLT)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、尿素氮(BUN)、血肌酐(SCr)、Na+等理化指标,以及肌红蛋白(MYO)和D-二聚体阳性率(MYO阳性阈值为107μg/L,D-二聚体阳性阈值为600μg/L),并比较各组指标的差异。绘制受试者工作特征曲线(ROC),分析MYO和D-二聚体对热射病的早期诊断价值。随访所有患者的转归,比较EHS与CHS患者的28 d病死率,探讨EHS患者经积极降温治疗4 h后的体温(T4 h)是否降到38 ℃以下与28 d病死率的关系。结果重症中暑以男性患者居多,特别是EHS患者,且EHS患者年龄较CHS患者更小,发病时间更短,各组间比较差异有统计学意义。EHS组及CHS组患者入院时体温和HR均明显高于对照组〔体温(℃):41.34±0.67、40.39±0.58比37.80±1.39,HR(次/min):139.78±15.63、113.08±17.70比92.00±15.89,均P<0.05〕,PLT均明显低于对照组(×10^9/L:164.94±73.80、165.78±53.49比249.50±84.22,均P<0.05),MYO和D-二聚体阳性率亦均明显高于对照组〔MYO阳性率:100.0%(18/18)、100.0%(12/12)比50.0%(4/8),D-二聚体阳性率:77.8%(14/18)、100.0%(12/12)比12.5%(1/8),均P<0.05〕。ROC曲线分析显示,患者入院时MYO和D-二聚体阳性对热射病均有一定诊断价值,ROC曲线下面积(AUC)分别为0.750、0.871,敏感度分别为50.0%、87.5%,特异度分别为100%、86.7%。EHS组患者28 d病死率明显高于CHS组〔44.4%(8/18)比8.3%(1/12),P<0.05〕;且EHS组中T4 h≥38℃患者28 d病死率明显高于T4 h<38℃者〔70.0%
Objective To explore the clinical characteristics and early sensitive indicators of severe heat stroke patients in order to predict the development of severe heat stroke in the early stage.Methods Thirty-eight patients with severe heat stroke admitted to emergency department of Beijing Daxing District People's Hospital from July 30th to August 5th in 2018 were enrolled.There were 18 patients suffered from exertional heat stroke(EHS),and 12 patients suffered from classical heat stroke(CHS),and 8 patients with heat spasm and heat exhaustion were selected as control group.The gender,age,onset time,body temperature,heart rate(HR),lactic acid(Lac),platelet(PLT),alanine aminotransferase(ALT),alanine aminotransferase(AST),blood urea nitrogen(BUN),serum creatinine(SCr),serum sodium at admission of hospital,as well as positive rate of myoglobin(MYO)and D-dimer(the positive threshold of MYO and D-dimer was 107μg/L and 600μg/L respectively)were recorded and compared among the groups.Receiver operating characteristic(ROC)curve was plotted to analyze the prognostic value of MYO and D-dimer on heat stroke.The outcome of all patients was followed up,and the 28-day mortality between EHS and CHS patients was compared.The patient's body temperature was measured again after 4 hours of active cooling treatment(T4 h),and the relationship between T4 h and 28-day mortality was discussed.Results The majority of severe heat stroke patients were male,especially in EHS patients.EHS patients were younger than CHS ones,and had shorter onset time,with significant differences among the groups.The body temperature and HR at admission in the EHS group and the CHS group were significantly higher than those in the control group[body temperature(℃):41.34±0.67,40.39±0.58 vs.37.80±1.39;HR(bpm):139.78±15.63,113.08±17.70 vs.92.00±15.89,all P<0.05],PLT was significantly lowered(×10^9/L:164.94±73.80,165.78±53.49 vs.249.50±84.22,both P<0.05),and the positive rates of MYO and D-dimer were also significantly increased[MYO positive rate:100.0%(
作者
刘庆鱼
李春盛
Liu Qingyu;Li Chunsheng(Department of Emergency,Beijing Daxing District People's Hospital,Beijing 102600,China;Department of Emergency,Beijing Friendship Hospital Affiliated to Capital Medical University,Beijing 100050,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2019年第5期594-597,共4页
Chinese Critical Care Medicine
基金
国家自然科学基金(81372025).
