CAJ | 학술논문

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。结果淤热射病并发MODS患者中,脑和肺最常被累及,分别为100.0%和96.6%。于24 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。盂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)。榆死亡组患者深昏迷、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>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。
목적：탐토로력성열사병치다장기공능장애종합정(MODS)적예후급영향인소。방법회고성분석소흥시인민의원2010년6월~2013년9월수치적29례로력성열사병치MODS환자적림상자료,안조예후정황분위사망조14례,호전조15례。채용APACHEⅡ평분계통대질병엄중정도진행평분비교。결과어열사병병발MODS환자중,뇌화폐최상피루급,분별위100.0%화96.6%。우24 h내사망원인주요위완고성휴극,24 h후사망원인주요위다장기공능쇠갈。치유11례,4례유유의식장애,생활불능자리。우사망조환자기병후래진시간위1.0~3.5 h,평균(2.50±0.68)h,호전조기병후래진시간위0.5~3.0 h,평균(1.65±0.60)h,호전조명현단우사망조,차이유고도통계학의의(P=0.001)；입원시APACHEⅡ평분,사망조위24~37분,평균(28.9±4.1)분,호전조위20~31분,평균(24.7±3.2)분,사망조APACHEⅡ평분명현고우호전조,차이유고도통계학의의(P=0.005)。유사망조환자심혼미、병발휴극적비례[71.4%(10/14)、100.0%(14/14)]명현고우호전조[13.3%(2/15)、60.0%(9/15)],차이유통계학의의(P<0.05)；량조체온≥40.5℃、호흡쇠갈、신공능쇠갈、미산성혈관내응혈、간공능쇠갈등병발증비례차이무통계학의의(P>0.05)。결론로력성열사병치MODS자병사솔고,급조식별、급시구치비상중요。
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 [1]In 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.[2]Shock 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. [3]The 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 APACHEIIscore 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 A-PACHEII score in death group was higher than that in improvement group, the difference was statistically significant (P=0.005).[4]The 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 combined with MODS has a high mortality, early recognition and treatment of these patients is very impor-tant.