劳力性热射病合并多器官功能障碍综合征29例临床分析  

Clinical analysis of 29 patients with exertional heat stroke combined with multiple organ dysfunction syndrome

作　　者：丁国娟[1,2] 任疆[1,2] 陈亚涛[1,2] 

机构地区：[1]浙江省绍兴市人民医院 [2]浙江大学绍兴医院急诊科,浙江绍兴312000

出　　处：《中国医药导报》2014年第19期59-61,68,共4页China Medical Herald

摘　　要：目的探讨劳力性热射病致多脏器功能障碍综合征（MODS）的预后及影响因素。方法回顾性分析绍兴市人民医院2010年6月～2013年9月收治的29例劳力性热射病致MODS患者的临床资料,按照预后情况分为死亡组14例,好转组15例。采用APACHEⅡ评分系统对疾病严重程度进行评分比较。结果①热射病并发MODS患者中,脑和肺最常被累及,分别为100.0%和96.6%。②24 h内死亡原因主要为顽固性休克,24 h后死亡原因主要为多脏器功能衰竭。治愈11例,4例遗有意识障碍,生活不能自理。③死亡组患者起病后来诊时间为1.0～3.5 h,平均（2.50±0.68）h,好转组起病后来诊时间为0.5～3.0 h,平均（1.65±0.60）h,好转组明显短于死亡组,差异有高度统计学意义（P=0.001）;入院时APACHEⅡ评分,死亡组为24～37分,平均（28.9±4.1）分,好转组为20～31分,平均（24.7±3.2）分,死亡组APACHEⅡ评分明显高于好转组,差异有高度统计学意义（P=0.005）。④死亡组患者深昏迷、并发休克的比例[71.4%（10/14）、100.0%（14/14）]明显高于好转组[13.3%（2/15）、60.0%（9/15）],差异有统计学意义（P〈0.05）;两组体温≥40.5℃、呼吸衰竭、肾功能衰竭、弥散性血管内凝血、肝功能衰竭等并发症比例差异无统计学意义（P＆gt;0.05）。结论劳力性热射病致MODS者病死率高,及早识别、及时救治非常重要。Objective To explore the prognosis and influencing factors of exertional heat stroke combined with multiple organ dysfunction syndromes（MODS）. Methods The clinical data of 29 exertional heat stroke patients with MODS from June 2010 to September 2013 in Shaoxing People＇s Hospital were retrospectively reviewed and divided into death group with 14 cases and improvement group with 15 cases according to the prognosis. The severity of illness was compared by APACHEⅡ scale. Results ①In all the 29 cases with exertional heat stroke combined with MODS, the brain and lung were commonest affected, the percentage was 100.0% and 96.6% respectively. ②Shock resistant was the main cause of death within 24 hours, multiple organ failure was the main cause of death over 24 hours. 11 cases were cured, 4 cases had consciousness disturbance and life disability. ③The onset of clinical time in death group was 1.0-3.5 hours, the average was（2.50±0.68） hours; the onset of clinical time in improvement group was 0.5-3.0 hours, the average was（1.65±0.60） hours; the onset of clinical time in improvement group was shorter than that in death group, the difference was statistically significant（P = 0.001）. The APACHEⅡ score in death group were 24-37 points, the average was（28.9±4.1）points, the APACHEⅡ score in improvement group were 20-31 points, the average was（24.7 ±3.2） points; the APACHEⅡ score in death group was higher than that in improvement group, the difference was statistically significant（P = 0.005）. ④The proportion of deep coma, shock in death group [71.4%（10/14）, 100.0%（14/14）] were higher than those in improvement group [13.3%（2/15）, 60.0%（9/15）], the differences were statistically significant（P〈0.05）. The differences of proportion of body temperature ≥40.5℃, respiratory failure, kidney failure, disseminated intravascular coagulation, hepatic failure between the two groups were not statistically significant（P〉0.05）. Conclusion Exertional heat stroke com

关 键 词：热射病 多脏器功能障碍 预后 

分 类 号：R59[医药卫生—内科学]