实验室检查结果与劳力性热射病预后的相关性分析

Correlation of major laboratory indexes with prognosis of exertional heatstroke： analysis of 16 cases

目的观察分析劳力性热射病血常规、生化、凝血等实验室检查结果，探讨部分指标与劳力性热射病病情严重性和预后的相关性。方法回顾性调查分析16例劳力性热射病患者的血常规、生化、凝血等主要实验室检查及主要项目的动态变化，进行脓毒症相关器官功能衰竭评分（SOFA），采用Fisher确切概率法分析两组间白细胞、血小板、肌酸磷酸激酶、凝血酶原时间、肌酐等指标的统计学差异。结果白细胞〉10×10^9／L的13例（81．25％），血小板减少10例（62．5％），凝血酶原时间延长14例（87．5％）。横纹肌、凝血、肾脏、心脏、肝脏等多个器官、多系统损害，器官损害多在1～5d内达到高峰。PT〉正常值10秒以上者在SOFA高分组占87．5％（7），显著高于低分组（2例，25．0％，P=0．041）。治愈14例（87．5％），2例（12．5％）因多器官功能衰竭死亡，1例发病第3天死亡，另1例发病第6天死亡。结论劳力性热射病可导致多器官功能障碍或衰竭。凝血酶原时间可作为劳力性热射病评价病情和预测预后的灵敏指标。

Objective To investigate the correlation of the severity of exertional heatstroke （EHS） with the values of blood routine, blood biochemistry, coagulation and other laboratory indexes. Methods Sixteen EHS patients, all males, aged （21.6±3.0）（18- 28）, underwent examination of blood routine, biochemistry, coagulation and other laboratory indexes dynamically. And sepsis related organ failure assessment （SOFA） score was calculated. The differences in white blood cells, platelets, creatine phosphokinase, prothromhin time, and creatinine were analyzed by Fisher exact probability statistical method. Results Eight patients were assigned into the group of SOFA high score （≥ 10）, and 8 into the group of SOFA low score 〈10）, There were 13 cases （81.25%） with the WBC〉10 ×10^9/L, 10 cases （62.5%） with thrombocytopenia, and 14 cases （87.5%） with prolonged prothrombin time （PT）. The damage of striated muscles, coagulation system, kidney, heart, liver and other organs reached the peak within 1-5 days. The percentage of those with the PT 〉10s in the SOFA high score group was 87.5% （7 cases）, significantly higher than that in the SOFA low score group （25.0%, 2 cases, P=0.041）. Conclusion EHS causes dysfunction or failure in many organs. The prothrombin time can be used as a sensitive indicator in the evaluation of prognosis of EHS.