老年热射病的早期识别和临床特征分析

Early Identification and Clinical Characteristics of Heat Stroke in the Elderly

目的探讨老年热射病的早期识别和临床特征,明确老年热射病的早期识别和预防。方法选取2010年8月—2017年8月因中暑的患者共28例,分为老年组和非老年组,老年组患者6例,平均年龄(68±4.6)岁。非老年组患者22例,平均年龄(44±12.0)岁。分别进行临床资料收集和比较两组热射病患者的易感因素、临床资料、检验及影像学检查资料、治疗结果和预后,分析老年热射病患者的相关因素和临床特征,对两组差异进行统计学分析。结果老年组中发生率较高的是经典型热射病,男:女比例为2:1,病情重、延迟诊断、死亡率高,老年组周围环境温度升高为主要诱发因素,非老年组,男:女比例为8:3,老年组热射病患者多逐渐起病,脱水症状较非老年组轻,入院时的高乳酸血症低于非老年组(P<0.05)。结论老年热射病患者发病临床诊断及治疗时间较长,合并肾功能衰竭、休克、DIC及多器官功能衰竭的可能性较非老年组大,临床预后需通过地区、环境、宿主及组织的综合因素来判断,重视暑期老年患者的居住环境温度及相关影响因素,达到早期识别和预防。

Objective To discuss the early identification and the clinical characteristics of heat stroke in the elderly. Methods 28 cases with heat stroke during the period from August, 2010 to August, 2017 were selected and divided into 2 groups：aged group（ n=6, average age： 68 ± 4.6） and non-aged group（ n=22, average age： 44 ±12.0）; the clinical data were collected and a comparative study betweren the 2 groups was made in predisposing factors, clinical data, lab test results, imaging examinations, treatment and prognosis; the related factors and clinical characteristics of heat stroke in the elderly were statistically analyzed and the differences between the 2 groups were discussed. Results The incidence of classic heat stroke in aged group was high with the gender ratio of 2 males to 1 female, with the charateristics of severe status, delayed diagnosis and high mortality,the environment temperature rising was the main inducing factor; the gender ratio in the incidence in non-aged group was 8 males to 3 females; the cases in aged group were more of a gradual onset with milder dehydration than the cases in non-aged group and the occurrence of hyperlacticemia at admission in aged group was lower than that in non-aged group（ P0.05）. Conclusions The time for clinical diagnosis and treatment in aged group was longer than taht in non-aged group and more complications such as renal dysfunction, shock, DIC and multiple organ failure（MOF） were found in aged group; the clinical prognosis should be comprehensively judged with the consideration of region, environment, virus hosts and tissues; attention to the temperature of the living condition of the elder and related influencing factors should be paid so as to gain early indentification and prevention of heat strok..