生理指标变化与5km武装越野训练致重症中暑的关系

Relationship between physiological parameters changes and severe heatstroke induced by 5-km armedcross-country training

目的探讨生理指标变化与5 km武装越野训练致重症中暑的关系。方法选择2016至2017年某特战队参加夏训5 km武装越野训练的男性官兵521例。所有训练人员均在外界环境温度〉32 ℃和（或）相对湿度〉65%的高温高湿环境中参加5 km武装越野训练，根据训练过程中是否发生重症中暑分为两组。对比分析两组训练人员的年龄、兵龄、体质评分、体重指数（BMI）、外界环境（如环境温度、相对湿度、风速、热指数），以及脱离训练5 min内动脉血氧饱和度（SaO2）、体温、脉搏、血压的变化率。采用二分类Logistic回归分析筛选出导致重症中暑的危险因素，并采用受试者工作特征曲线（ROC）分析各项危险因素对重症中暑的预测价值。结果521例5 km武装越野训练人员在训练过程中发生重症中暑29例，发生率5.57%；发生重症中暑与未发生重症中暑人员年龄、兵龄、体质评分、BMI等一般情况以及5 km武装越野训练所处外界环境等比较差异均无统计学意义。与未发生重症中暑人员比较，重症中暑人员脱离训练5 min内体温、脉搏、血压降变率及SaO2升高率均显著降低〔体温降变率：（0.67±0.30）%比（1.43±1.28）%，脉搏降变率：（7.53±5.21）%比（13.48±8.07）%，血压降变率：（9.28±6.84）%比（19.42±7.73）%，SaO2升高率：（0.51±0.39）%比（1.50±1.43）%，均P〈0.01〕。二分类Logistic回归分析显示，体温降变率〔优势比（OR）＝0.485，95%可信区间（95%CI）＝0.289～0.817〕、脉搏降变率（OR＝0.903，95%CI＝0.845～0.965）、血压降变率（OR＝0.841，95%CI＝0.790～0.896）、SaO2升高率（OR＝0.421，95%CI＝0.250～0.711）是5 km武装越野训练过程中发生重症中暑的危险因素（均P〈0.01）。ROC曲线分析显示，体温降变率〔ROC曲线下面积（AUC）＝0.659，95%CI＝0.604～0.714〕、脉搏降变率（AUC＝0.730，95%CI＝0.762～0.900）、血压降变率（AUC＝0.831，95%CI＝0.659～0.801）、SaO2升高率（AUC＝0.711，95%CI＝0.655～0.767）均可用于预测5 km武装越野训练过程中重症中暑的发生（均P〈0.01），且具有同等的预测价值。结论在同等条件下，5 km武装越野训练人员脱离训练5 min内体温、脉搏、血压降变率及SaO2升高率是发生重症中暑的危险因素，且对重症中暑具有同等的预测价值。

ObjectiveTo explore the relationship between physiological parameters changes and severe heatstroke induced by 5-km armed cross-country training.MethodsA total of 521 male officers and soldiers from a special team who participated in the summer training of 5-km armed cross-country training from year 2016 to 2017 were enrolled. All trainees participated in 5-km armed cross-country training in high temperature and humidity environment of ambient temperature 〉 32℃and （or） relative humidity 〉 65%. The trainees were divided into two groups according to the incidence of severe heatstroke in the course of training. The age, enlistment time, constitution score, body mass index （BMI）, external environment （ambient temperature, relative humidity, wind speed, heat index） of trainees of the two groups, and the change rates of arterial blood oxygen saturation （SaO2）, body temperature, pulse and blood pressure within 5 minutes after the 5-km armed cross-country training were compared between the two groups. The risk factors of severe heatstroke were screened by two classified Logistic regression analysis, and the predictive value of various risk factors of severe heatstroke was analyzed by the receiver operator characteristic curve （ROC）.ResultsIn 521 trainees of 5-km armed cross-country training, 29 trainees suffered from severe heatstroke accounting for 5.57%. There was no significant difference in the age, enlistment time, constitution score, BMI, or external environment during 5-km armed cross-country training between severe heatstroke group and non-severe heatstroke group. Compared with those without severe heatstroke, the descending rates of body temperature, pulse, blood pressure and SaO2 increased rate within 5 minutes after 5-km armed cross-country training of severe heatstroke trainees were significantly decreased [temperature descending rate： （0.67±0.30）% vs. （1.43±1.28）%, pulse descending rate： （7.53±5.21）% vs. （13.48±8.07）%, blood pressure descending rate： （9.28±6.84）% vs. （19.42±7.73）%, SaO2 increased rate： （0.51±0.39）% vs. （1.50±1.43）%, all P 〈 0.01]. Two classification Logistic regression analysis showed that the temperature descending rate [odds ratio （OR） = 0.485, 95% confidence interval （95%CI） = 0.289-0.817], pulse descending rate （OR = 0.903, 95%CI = 0.845-0.965）, blood pressure descending rate （OR = 0.841, 95%CI = 0.790-0.896）, and SaO2 increased rate （OR = 0.421, 95%CI = 0.250-0.711） were the risk factors for severe heatstroke during 5-km armed cross-country training （all P 〈 0.01）. ROC curve analysis showed that temperature descending rate [area under ROC curve （AUC） = 0.659, 95%CI = 0.604-0.714], pulse descending rate （AUC = 0.730, 95%CI = 0.762-0.900）, blood pressure descending rate （AUC = 0.831, 95%CI = 0.659-0.801）, SaO2 increased rate （AUC = 0.711, 95%CI = 0.655-0.767） could be used for the incidence of severe heatstroke prediction during 5-km armed cross-country training （all P 〈 0.01）, and the predicted value was the same.ConclusionsUnder the same conditions, the severe heatstroke during 5-km cross-country training is closely related to the descending rates of body temperature, pulse, and blood pressure as well as SaO2 increased rate within 5 minutes after the training, whose predictive values for severe heatstroke were the same.