影响劳力性热射病预后的危险因素分析

Analysis of risk factors affecting prognosis of exertional heat stroke

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.

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.