亚低温对热射病治疗效果的影响及对心肌的保护

Treatment effect and myocardium protection of low temperature on heat stroke

目的研究亚低温对热射病治疗效果的影响及对心肌的保护。方法选取67例热射病患者,根据抽取法分为试验组(34例)和对照组(33例)。对照组采取常规物理降温处理,试验组在此基础上采取亚低温进行治疗。评价患者治疗前,治疗后1、2、3、5 d急性生理功能和慢性健康状态评分系统II(acute physiology and chronic health evaluationscoring system II,APACHE II)、GCS(Glasgow coma score)评分,比较两组患者治疗前和治疗后5 d血液成份、心肌标志物、生命体征变化。结果治疗后5 d,试验组的血小板计数(201.43±17.43)×109/L高于对照组(143.54±14.21)×109/L,血细胞比容、血细胞计数[(25.15±2.56)%、(7.32±0.87)×109/L]低于对照组[(30.52±3.54)%、(11.43±1.52)×109/L],差异有统计学意义(P<0.05)。试验组的心肌肌钙蛋白I、肌酸激酶、肌酸激酶同工酶[(2.14±0.12)ng/L、(184.53±11.42)U/L、(18.03±2.41)IU/L]低于对照组[(5.18±0.14)ng/L、(235.32±16.25)U/L、(26.05±3.35)IU/L],差异有统计学意义(P<0.05)。试验组的平均动脉压(90.43±6.11)mm Hg高于对照组(82.64±4.31)mm Hg,体温、心率、呼吸频率[(36.35±0.23)℃、(83.24±6.32)次/min、(18.98±2.15)次/min]低于对照组[(37.98±0.87)℃、(117.87±11.76)次/min、(23.87±4.51)次/min],差异有统计学意义(P<0.05)。治疗后5 d,试验组的APACHE II评分[(19.42±1.56)分]低于对照组[(22.43±2.08)分],GCS评分[(16.32±2.87)分]高于对照组[(12.04±2.52)分],差异有统计学意义(P<0.05)。试验组的高热、腹胀、心跳过快发生率及病死率(8.82%、5.88%、2.94%、11.76%)低于对照组(33.33%、24.24%、18.18%、45.45%),差异有统计学意义(P<0.05)。结论热射病患者采取亚低温治疗措施,能明显改善患者的临床症状,保护心肌功能,降低病死率。

Objective To determine the therapeutic effect and myocardium protection of low temperature on heat stroke.Methods A total of 67 cases of heat stroke were subjected in this study. They were divided into experimental group（n=34）and control group（n=33）according to the extracting method. The control group were given routine physical cooling treatment,and those of the experimental group were treated with low temperature treatment besides the routine treatment as the control group. Acute physiology and chronic health evaluation scoring system II（APACHE II）,Glasgow coma score（GCS）were used toevaluate the patients before and in 1,2,3 and 5 d after treatment. Blood components,myocardial markers,and vital signschange were compared in the 2 groups of patients before and in 5 d after treatment. Results In 5 d after treatment,the experimental group had significantly higher platelet count [（201.43 ± 17.43）× 10^9/L vs（143.54 ± 14.21）× 10^9/L],lowerhematocrit [（25.15±2.56）% vs（30.52±3.54）%],and lower blood count [（7.32±0.87）×10^9/L vs（11.43±1.52）×10^9/L] whencompared with the control group（all P〈0.05）. The levels of cardiac troponin I（c Tn I）,creatine kinase（CK）and creatine kinaseisoenzyme（CK- MB）were obviously lower in the experimental group than the control group[（2.14 ± 0.12） ng/L vs（5.18 ± 0.14） ng/L,（184.53 ± 11.42） U/L vs（235.32 ± 16.25） U/L,（18.03 ± 2.41） IU/L vs（26.05 ± 3.35） IU/L,P〈0.05]. Whencompared with the control group,the experimental group also had higher mean arterial pressure[（90.43±6.11） mm Hg vs（82.64±4.31） mm Hg],and lower body temperature,heart rate and breathing rate[（36.35±0.23） ℃ vs（37.98±0.87） ℃,（83.24±6.32）times/min vs（117.87±11.76） times/min,（18.98±2.15）times/min vs 23.87±4.51）times/min,P〈0.05]. In 5 d after treatment,the APACHE II score was lower[（19.42±1.56） vs（22.43±2.08）],but the GCS score was lower in the experimental group than the control group[（16.32 ±2.87） vs（12.04±2.52）,P〈0.05]. The incidences of high fever,abdominal distension,tachycardia,and death were lower in the experimental group than the control group（8.82%vs 33.33%,5.88%vs 24.24%,2.94% vs 18.18%,11.76% vs 45.45%,P〈0.05）. Conclusion Low temperature treatment can improve the clinical symptoms,protect the myocardial function,and reduce the mortality in the patients of heat stroke.