中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2013年
9期
515-518
,共4页
赵佳佳%周京江%胡婕%周飞虎%康红军%刘辉%潘亮%宋青
趙佳佳%週京江%鬍婕%週飛虎%康紅軍%劉輝%潘亮%宋青
조가가%주경강%호첩%주비호%강홍군%류휘%반량%송청
劳力性热射病%预后%危险因素%弥散性血管内凝血%急性肾损伤
勞力性熱射病%預後%危險因素%瀰散性血管內凝血%急性腎損傷
로력성열사병%예후%위험인소%미산성혈관내응혈%급성신손상
Exertional heat stroke%Prognosis%Risk Factor%Disseminated intravascular coagulation%Acute kidney injury
目的 探讨影响劳力性热射病(EHS)预后的危险因素.方法 收集2002年6月至2012年8月期间10家部队医院资料完整的69例EHS患者的主要临床参数及预后情况,包括是否合并横纹肌溶解(RM)、弥散性血管内凝血(DIC)、急性肾损伤(AKI)、肝功能障碍、继发性癫痫、休克、心律失常、多器官功能障碍综合征(MODS)及意识状态等9个主要临床参数.进行logistic多因素回归分析,筛选出与EHS预后有关的主要危险因素,并验证其准确性和可靠性.结果 EHS患者69例,以出院为观察终点,死亡18例,病死率26.09%;DIC、AKI为影响预后的独立危险因素[DIC优势比(OR) =94.994,95%可信区间(95%CI)为3.837~2352.031,P=0.005; AKI OR=90.871,95%CI为2.079~3971.995,P=0.019];其中DIC和AKI任何一个因素单独存在的病死率为16.67% (3/18);DIC和AKI同时存在的病死率为93.75%(15/16),其敏感度为83.33%,特异度为98.03%,阳性预测值为93.75%,阴性预测值为94.34%,准确性为94.20%.结论 EHS患者合并DIC、AKI为影响预后的主要危险因素;如同时存在DIC、AKI 2个因素的EHS患者,死亡风险极高.
目的 探討影響勞力性熱射病(EHS)預後的危險因素.方法 收集2002年6月至2012年8月期間10傢部隊醫院資料完整的69例EHS患者的主要臨床參數及預後情況,包括是否閤併橫紋肌溶解(RM)、瀰散性血管內凝血(DIC)、急性腎損傷(AKI)、肝功能障礙、繼髮性癲癇、休剋、心律失常、多器官功能障礙綜閤徵(MODS)及意識狀態等9箇主要臨床參數.進行logistic多因素迴歸分析,篩選齣與EHS預後有關的主要危險因素,併驗證其準確性和可靠性.結果 EHS患者69例,以齣院為觀察終點,死亡18例,病死率26.09%;DIC、AKI為影響預後的獨立危險因素[DIC優勢比(OR) =94.994,95%可信區間(95%CI)為3.837~2352.031,P=0.005; AKI OR=90.871,95%CI為2.079~3971.995,P=0.019];其中DIC和AKI任何一箇因素單獨存在的病死率為16.67% (3/18);DIC和AKI同時存在的病死率為93.75%(15/16),其敏感度為83.33%,特異度為98.03%,暘性預測值為93.75%,陰性預測值為94.34%,準確性為94.20%.結論 EHS患者閤併DIC、AKI為影響預後的主要危險因素;如同時存在DIC、AKI 2箇因素的EHS患者,死亡風險極高.
목적 탐토영향로력성열사병(EHS)예후적위험인소.방법 수집2002년6월지2012년8월기간10가부대의원자료완정적69례EHS환자적주요림상삼수급예후정황,포괄시부합병횡문기용해(RM)、미산성혈관내응혈(DIC)、급성신손상(AKI)、간공능장애、계발성전간、휴극、심률실상、다기관공능장애종합정(MODS)급의식상태등9개주요림상삼수.진행logistic다인소회귀분석,사선출여EHS예후유관적주요위험인소,병험증기준학성화가고성.결과 EHS환자69례,이출원위관찰종점,사망18례,병사솔26.09%;DIC、AKI위영향예후적독립위험인소[DIC우세비(OR) =94.994,95%가신구간(95%CI)위3.837~2352.031,P=0.005; AKI OR=90.871,95%CI위2.079~3971.995,P=0.019];기중DIC화AKI임하일개인소단독존재적병사솔위16.67% (3/18);DIC화AKI동시존재적병사솔위93.75%(15/16),기민감도위83.33%,특이도위98.03%,양성예측치위93.75%,음성예측치위94.34%,준학성위94.20%.결론 EHS환자합병DIC、AKI위영향예후적주요위험인소;여동시존재DIC、AKI 2개인소적EHS환자,사망풍험겁고.
Objective To determine prognostic risk factors of exertional heat stroke (EHS).Methods Sixty-nine patients who met the case definition of EHS at ten military hospitals from June 2002 to August 2012 were enrolled in this retrospective study.The clinical data and prognosis was observed,including rhabdomyolysis (RM),disseminated intravascular coagulation (DIC),acute kidney injury (AKI),hepatosis,epilepsy,shock,arrhythmia,multiple organ dysfunction syndrome (MODS) and consciousness disorder.A logistic regression analysis was made to look for the significant risk factors,and its accuracy and reliability were tested and verified by statistical equation.Results There were 69 patients with EHS in the study,and 18 (26.09%) were dead.The independent prognostic factors were identified as DIC and AKI [DIC odds ratio (OR) =94.994,95% confidence interval (95% CI)3.837-2352.031,P=0.005; AKI OR=90.871,95%CI 2.079-3971.995,P=0.019].The mortality was 16.67% (3/18) when any one factor exist; the mortality was 93.75% (15/16) when two factors exist (sensibility was 83.33%; with specificity of 98.03%,positive predictive value of 93.75%,negative predictive value of 94.34%,and accuracy of 94.20%).Conclusions Among all the clinical parameters,the major risk factors affecting prognosis of EHS included DIC and AKI.The mortality might go very high if both two risk factors exist.