劳力性和非劳力性热射病致凝血功能障碍比较分析

Clinical comparative research on exertional and classic heatstroke induced coagulopathy

目的对近8年来笔者所在医院收治的劳力性热射病（exertionalheatstroke，EHS）和非劳力性热射病（classicheatstroke，CHS）患者临床资料进行比较分析、总结。方法收集2006年-2013年人住解放军89医院的热射病患者23例，其中劳力性热射病患者13例，为EHS组；非劳力性热射病患者10例，为CHS组。另选取8例同时期的轻中度中暑患者为对照组。记录分析纳入本研究患者的一般资料、实验室检查指标和临床治疗措施以及预后等，运用统计学方法比较分析三组患者的血常规、凝血四项检验指标的变化情况。结果CHS组患者较EHS组和对照组平均发病年龄偏高，基础疾病多，后遗症多；三组白细胞（whitebloodcell，WBC）计数均较正常值[（4—10）×109／L]偏高，但组间比较无显著性差异（P〉 0．05）；EHS组患者入院时血小板（platelet，PLT）计数明显低于对照组（P〈0．05），住院期间PLT峰值明显低于对照组和CHS组，P〈0．05，差异有统计学意义；EHS组患者人院时凝血酶原时间（thrombintime，Pr）、活化部分凝血酶原时间（activatedpartialthromboplastintime，APrr）及住院期间PT、APPT峰值与CHS组和对照组比较明显延长，P〈0．05，差异有统计学意义；CHS患者入院时PT、APTT及住院期间PT、AnT峰值与对照组比较无显著性差异（P〉0．05）。结论CHS多见于老年体弱患者，多伴有基础疾病，多遗留后遗症；实验室检查结果显示，EHS和CHS患者出现明显的凝血功能障碍，且以EHS患者更严重，这可能是EHS致多器官功能障碍的主要发病机制。

Objective Clinical data of heatstroke patients which collected in author＇s hospital over past 8 yrs were analyzed. Methods The 23 cases of heatstroke,which collected in 89 People＇s Liberation Army Hospital 2006-2013,were divided into three groups： exertional heatstroke group （EHS group,13 cases）,non-exertional （classic） heatstroke group （CHS group,10 cases）,and 8 mild to moderate stroke cases as a control group. The general situation,clinical manifestation and lab exam parameters including blood routine test,blood clotting,liver function,renal function,muscle acid kinase were recorded and statistically analyzed. Results Compared with either EHS or control group,the CHS patients were older,more with underlying diseases and worse prognosis. White blood cells （WBC） of these three groups were increased,while there was no difference among groups （P〉0.05）. Platelet（PLT） of EHS patients at the beginning of admitted hospital is higher than control（P〈0.05） and PLT peak was higher than control and CHS （P〈0.05）. Thrombin time （PT） and activated partial thremboplastin time（APTl＇） of EHS patients either at the beginning and the peak were longer than control and CHS（P〈0.05）,while there was no significant difference between CHS and control（P〉0.05）. Conclusion CHS is more common in older patients, and who with underlying diseases and worse prognosis. Laboratory tests show that EHS and CHS patients are with significant coagulation disorders,and EHS is more severe. Above factors may contribute to the pathogenesis of HS induced multiple organ dysfunction.