摘要
目的研究热射病性休克的临床特征。方法回顾性分析联勤保障部队第九〇八医院重症医学科2019年6月至2024年2月收治的休克患者,根据病因分为热射病性休克组(n=17)和脓毒性休克组(n=18),收集患者入科时的血常规、生化指标、凝血常规试验、血栓弹力图和血流动力学参数包括平均动脉压(MAP)、连续心输出量指数(PCCI)、全心舒张末期容积指数(GEDVI)、外周血管阻力指数(SVRI)和血管外肺水指数(ELWI),对两组间是否存在差异进行统计学分析,采用生存分析Kaplan-Meier法比较两组患者的14 d存活率。结果与脓毒性休克组比较,热射病性休克组患者MAP、PCCI、GEDVI和SVRI差异无统计学意义(P>0.05);与脓毒性休克组比较,热射病性休克组ELWI[12.00(8.00~16.00)mL/kg vs.7.00(6.00~9.00)mL/kg]、纤维蛋白原水平[2.97(2.49,4.63)g/L vs.1.80(1.42,2.41)g/L]、格拉斯哥昏迷评分[12.00(8.25,13.25)vs.3.00(3.00,4.00)]和TEG-MA[(57.71±10.92)mm vs.(44.18±10.01)mm]更低,凝血酶时间[16.2(15.1,18.5)s vs.19.7(17.3,22.2)s]和TEG-K[2.65(1.48,3.90)min vs.5.10(2.50,6.65)min]更长,肌酸激酶[316(128,864)U/L vs.2559(555,3845)U/L]更高(均P<0.05)。结论热射病性休克与脓毒性休克的血流动力学均呈现高排特征,且相对于脓毒性休克,热射病性休克患者凝血障碍、中枢障碍和横纹肌损伤更严重。
Objective To investigate the clinical characteristics of heat stroke-induced shock.Methods A retrospective analysis was conducted on the clinical data of 17 patients with heat stroke-induced shock and 18 patients with septic shock admitted to the Department of Critical Care Medicine of No.908th Hospital of Joint Logistics Support Force of Chinese PLA from June 2019 to February 2024.At admission,complete blood count,blood biochemistry,coagulation profile,thromboelastography(TEG),and hemodynamic parameters including mean arterial pressure(MAP),cardiac index(CI),global end-diastolic volume index(GEDVI),peripheral vascular resistance index(SVRI),as well as extravascular lung water index(ELWI)were collected for statistical analysis.Kaplan-Meier survival analysis was performed to compare 14 d survival rate between two groups.Results There were no significant differences in MAP,cardiae index,GEDVI and SVRI between the heat stroke-induced shock group and the septic shock group(P>0.05).However,the heat stroke-induced shock group had significantly lower ELWI[7.00(6.00-9.00)mL/kg vs.12.00(8.00-16.00)mL/kg],fibrinogen[1.80(1.42,2.41)g/L vs.2.97(2.49,4.63)g/L],Glasgow coma scale[3.00(3.00,4.00)vs.12.00(8.25,13.25)],and TEG-MA[(44.18±10.01)mm vs.(57.71±10.92)mm],the significantly longer thrombin time[19.7(17.3,22.2)s vs.16.2(15.1,18.5)s]and TEG-K[5.10(2.50,6.65)min vs.2.65(1.48,3.90)min],and the significantly higher creatine kinase[2559(555,3845)U/L vs.316(128,864)U/L],compared with the septic shock group(all P<0.05).Conclusions Both heat stroke-induced shock and septic shock present with hyperdynamic circulation,but heat stroke-induced shock is characterized by more severe coagulopathy,central nervous system impairment,and rhabdomyolysis.
作者
万小雷
宋景春
余永春
曾俊杰
宋晓敏
徐咪咪
彭恩兰
Wan Xiaolei;Song Jingchun;Yu Yongchun;Zeng Junjie;Song Xiaomin;Xu Mimi;Peng Enlan(Department of Critical Care Medicine,No.908th Hospital of Joint Logistic Support Force of Chinese PLA,Nanchang 330002,China)
出处
《中国急救医学》
CAS
CSCD
2024年第6期521-525,共5页
Chinese Journal of Critical Care Medicine
基金
2022年全军基础加强计划项目(2022-JCJQ-ZD-097-11)
中国医药教育协会2022重大科学攻关课题(2022KTZ013)
江西省卫健委科技计划(202311381)。
关键词
热射病
休克
脓毒症
血流动力学
凝血障碍
中枢障碍
横纹肌溶解症
Heat stroke
Shock
Sepsis
Hemodynamics
Coagulation dysfunction
Central nervous system impairment
Rhabdomyolysis
