院外救治69例中暑患者不同结局的影响因素

Analysis of pre-hospital rescue for heatstroke in 69 patients

目的分析接受院外救治的急性中暑患者不同结局的影响因素。方法回顾分析69例中暑患者的临床特征及收治效果,按照疗效标准将69例中暑患者分为两组。治疗无效组12例,其中死亡2例,病情严重者10例(院外救治症状改善不明显,收住入院进一步治疗);治疗有效组57例,包括经院前治疗和院内急诊治疗症状缓解和痊愈的中暑者。分析其中暑类型、性别组成、年龄结构、疾病严重程度、基础疾病(2个)、并发症、从发病至救治时间。结果治疗无效组老年患者比例高于治疗有效组(83.3%比49.1%,P<0.05)。治疗无效组重症患者比例多于治疗有效组(100%比38.6%,P<0.05)。治疗无效组合并基础疾病患者比例较高(66.7%比26.3%,P<0.01)。治疗无效组有并发症者比例高于治疗有效组(83.3%比66.7%,P<0.05)。治疗无效组发病到救治的时间长于治疗有效组(P<0.01),重症患者中治疗有效组发病到救治的时间短于治疗无效组(P<0.05)。中暑抢救成功率为82.6%。结论高龄、疾病的严重程度、基础疾病、出现并发症及就诊时间长短影响中暑患者院外救治的成功率,如能控制以上各因素,或可提高中暑患者抢救成功率。

Objective To analyze the factors related to different outcomes of acute heatstroke pa- tients accepting pre-hospital care. Methods The clinical features and treatment effect of 69 heatstroke cases were retrospectively analyzed. Sixty-nine cases were divided into two groups （ineffective treatment group and effective treatment group） according to different curative effects. There were 12 cases in ineffective treatment group （including two dead and 10 severe cases）, and 57 cases in effective treatment group includeing patients with pre-hospital rescue and in hospital treatment. The types of heatsroke, sex distinction, age composition, severity of the disease, two or more coexisted diseases, complications and the time of onset to treatment were all compared among patients in the two groups. Results The proportion of elderly patients （83. 3% ） in inef- fective treatment group was higher than that of the effective group（49. 1% ） （P 〈0. 05） ; the proportion of pa- tients with severe conditions in ineffective treatment group was obviously more than that of the effective treat- ment group （38. 6% ） （P 〈 0. 05 ）; the percentage of coexisted diseases in ineffective treatment group （66. 7% ） is higher than that of the effective group （26. 3% ） （P 〈0. 01） ; the percentage of patients with com- plications in ineffective treatment group （83. 3% ） is higher than that of the effective treatment group （66. 7% ） （P 〈0. 05） ; ineffective treatment group had a longer time of onset to treatment（368. 2 ± 115. 9 rain） than that of the effective group （77. 9±22. 2 rain）（P 〈0. 01）; while severe patients in effective group had a shorter time from onset to treatment （P 〈 0. 05）. The rescue success rate of pre-hospital care for heatstroke was 82. 6%. Conclusion Age, coexisted diseases, complications and the time of onset to treatment were all the factors ＂affecting the success rate of the pre-hospital care for heatstroke patients. The controlling of the a- bove factors might improve the success rate of rescue heatstroke patients.