摘要
目的 探讨血浆置换(TPE)介入时机及肝损伤分期辅助治疗劳力性热射病患者(EHS)的预后影响及临床应用价值。方法 收集2011年1月—2023年12月在中国人民解放军总医院第一医学中心收治的EHS患者127例,根据临床结局分为死亡组与生存组2组,根据ALT、AST、TBIL、DBIL指标动态变化分为5期;经倾向性评分匹配分析,生存组11例、死亡组12例被纳入统计分析。行TPE辅助治疗20例;观察治疗前后指标变化及临床结局,评价介入时机对预后的影响。结果 23例患者中,没有肝损伤和可进展到肝脏修复期的共14例,死亡3例、病死率21.43%;不能进展到肝脏修复期9例,死亡9例,病死率100%,2者比较有差异(P<0.05)。首次TPE如在肝损伤第3期之前介入的病死率为23.08%(3/13),达到或超过第3期才介入的病死率85.71%(6/7),2者比较有差异(P<0.05)。结论 EHS合并肝损伤的患者应在肝损伤第3期之前积极行TPE治疗,阻断其病理生理过程,使之跃过第3期,从而改善预后和降低病死率。
Objective To explore the prognostic impact and clinical application value of therapeutic plasma exchange(TPE) intervention timing and liver injury periodization in patients with exertional heat stroke(EHS).Methods Data of 127 EHS patients from the First Medical Center of the General Hospital of the People′s Liberation Army from January 2011 to December 2023 were collected,then divided into the death group and the survival group based on therapeutic outcomes and into 5 stages according to the dynamic changes of ALT,AST,TBIL and DBIL.According to propensity score matching analysis,11 patients in the survival group and 12 patients in the death group were included in the statistical analysis,and 20 of them were treated with TPE.The changes in indicators and clinical outcomes before and after TPE were observed,in order to evaluate the impact of intervention timing on prognosis.Results Among the 23 patients,14 had no liver injury or could progress to the repair phase,resulting in 3 deaths(with the mortality rate of 21.43%),while 9 patients failed to progress to the repair phase,resulting in 9 deaths(with the mortality rate of 100%),with significant differences(P<0.05).The mortality rate of the first TPE intervention before the third stage of liver injury was 23.08%(3/13),while that of intervention after reaching or exceeding the third stage was 85.71%(6/7),and the difference was statistically significant(P<0.05).Conclusion TPE should be executed actively in EHS patients combined with liver injury before the third phase to lock its pathological and physiological processes,thereby improving prognosis and reducing mortality.
作者
何宗忠
王敏
庄远
林洁
张雷英
邹立洋
李玲玲
马春娅
刘晓敏
权香
江颖
周谋
康红军
于洋
HE Zongzhong;WANG Min;ZHUANG Yuan;LIN Jie;ZHANG Leiying;ZOU Liyang;LI Lingling;MA Chunya;LIU Xiaomin;QUAN Xiang;JIANG Ying;ZHOU Mou;KANG Hongjun;YU Yang(Department of Blood Transfusion Medicine,The First Medical Center,The General Hospital of PLA,Beijing 100853,China;Department of Blood Transfusion Medicine,General Hospital of Southern Theatre Command;Department of Critical Care Medicine,The First Medical Centre,The General Hospital of PLA)
出处
《中国输血杂志》
CAS
2024年第7期728-733,共6页
Chinese Journal of Blood Transfusion
关键词
劳力性热射病
肝损伤
血浆置换
exertional heat stroke(EHS)
liver injury
therapeutic plasma exchange
