中暑患者发生热射病危险因素分析  

Risk factors of heatstroke in patients with heat illness

作　　者：钟林翠 宋景春[1] 高燕 李庆华[3] 李海玲 宋青 ZHONG Lin-cui;SONG Jing-chun;GAO Yan;LI Qing-hua;LI Hai-ling;SONG Qing(Intensive Care Unit,the 908th Hospital of Chinese PLA Logistical Support Force,Nanchang 330002,China)

机构地区：[1]中国人民解放军联勤保障部队第九〇八医院重症医学科,江西南昌330002 [2]北部战区总医院急诊医学部,辽宁沈阳110016 [3]中国人民解放军联勤保障部队第九九〇医院重症医学科,河南驻马店463000 [4]中国人民解放军海军第九七一医院重症医学科,山东青岛266071 [5]中国人民解放军总医院海南医院重症医学科,海南三亚572013

出　　处：《创伤与急危重病医学》2022年第2期97-99,104,共4页Trauma and Critical Care Medicine

基　　金：全军热射病防治体系建设专项(20210522);军事医学创新工程专项(18CXZ024)。

摘　　要：目的研究军队医院收治的中暑患者中热射病发生的危险因素。方法收集24家军队医院急诊或重症医学科2021年3—11月收治的274例中暑患者,根据诊断分为热射病组(n=92)与非热射病组(n=182)。收集两组患者的基础资料、血常规、肝肾功能、肌酸激酶、凝血指标,并进行统计学分析。结果与非热射病组比较,热射病组患者白细胞计数、血红蛋白、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、肌酸激酶水平明显升高,凝血酶原时间和凝血酶时间明显延长,差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,凝血酶时间是热射病发生的独立危险因素(P<0.05)。受试者工作特征(ROC)曲线分析显示,凝血酶时间判断热射病发生的ROC曲线下面积为0.69(95%可信区间0.63~0.76,P<0.001)。取凝血酶时间为17.4 s时,诊断热射病的敏感度和特异度依次为0.61和0.70。当凝血酶时间>17.4 s时,热射病的发生率显著升高,差异有统计学意义(P<0.05)。结论凝血酶时间>17.4 s是中暑患者发生热射病的独立危险因素。Objective To study the risk factors of heatstroke in patients with heat illness admitted to military hospitals.Methods The data of 274 patients with heat illness admitted to the emergency department or the intensive care unit of 24 military hospitals from March 2021 to November 2021 were retrospectively analyzed.According to the diagnosis,the patients were divided into heatstroke group(n=92)and non-heatstroke group(n=182).The basic data,blood routine,liver and kidney function,creatine kinase,routine coagulation items of the two groups of patients were collected,and the difference was compared between the two groups.Results Compared with the non-heatstroke group,the levels of white blood cells,hemoglobin,alanine aminotransferase,aspartate aminotransferase and creatine kinase in the heatstroke group were significantly increased,prothrombin time and thrombin time were significantly prolonged(P<0.05).Binary Logistic regression analysis showed that thrombin time was a risk factor for heatstroke(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the area under the ROC curve of thrombin time to judge the occurrence of heatstroke was 0.69(95%CI:0.63-0.76,P<0.001).When thrombin time was 17.4 s,the sensitivity and specificity for the diagnosis of heatstroke were 0.61 and 0.70,respectively.Conclusion Thrombin time over 17.4 s is an independent risk factor for the development of heatstroke in patients with heat illness.

关 键 词：中暑 热射病 凝血酶时间 危险因素 

分 类 号：R594.12[医药卫生—内科学]