早期持续性血液净化治疗对热射病预后的影响

Influence of early continuous blood purification on prognosis of heat stroke

目的探讨热射病患者早期血液净化治疗对预后的影响。方法回顾性分析我科2017年6月~2018年9月收治的23例热射病患者的临床资料,按照是否早期给予持续血液净化治疗分为观察组(12例)和对照组(11例)。观察组早期给予持续血液净化治疗,对照组给予常规治疗。比较两组患者治疗24、48 h后的血压、呼吸、心率、体温等生命体征及肌酐(Cr)、丙氨酸氨基转移酶(ALT)、肌酸磷化酶-同工酶(CK-MB)等生化指标变化及最终预后。结果两组患者治疗24 h后的体温及心率均低于治疗前,血压及氧合指数均高于治疗前,差异有统计学意义(P<0.05);观察组患者治疗24 h后的体温及心率低于对照组,血压及氧合指数高于对照组,差异有统计学意义(P<0.05);两组患者治疗48 h后的体温、心率、血压及氧合指数等指标比较,差异无统计学意义(P>0.05);观察组患者治疗24、48 h后监测的Cr、ALT、CK-MB等生化指标均低于对照组,差异有统计学意义(P<0.05)。观察组无1例死亡,病死率为0.0%;对照组死亡3例,病死率为27.3%,两组比较差异有统计学意义(P<0.01)。结论热射病患者早期持续血液净化治疗可以改善症状,降低病死率。

Objective To explore the influence of early blood purification on prognosis in patients with heat stroke.Methods The clinical data of 23 patients with heat stroke admitted to our department from June 2017 to September 2018 were analyzed retrospectively.The patients were divided into the observation group(12 cases)and the control group(11 cases)according to whether they were given continuous blood purification treatment in the early stage or not.The observation group was given continuous blood purification treatment in the early stage,while the control group was given routine treatment.The changes of blood pressure,respiration,heart rate,body temperature,creatinine(Cr),alanine aminotransferase(ALT),creatine phosphorylase-isoenzyme(CK-MB)and the final prognosis were compared between the two groups after 24 and 48 hours of treatment.Results The body temperature and heart rate of the two groups after 24 hours of treatment were lower than those before treatment,and the blood pressure and oxygenation index of the two groups after 24 hours of treatment were higher than those before treatment,the differences were statistically significant(P<0.05).The body temperature and heart rate of the observation group were lower than those of the control group after 24 hours of treatment,and the blood pressure and oxygenation index of the two groups after 24 hours of treatment were higher than those of the control group,the differences were statistically significant(P<0.05).There was no significant difference in body temperature,heart rate,blood pressure and oxygenation index between the two groups after 48 hours of treatment(P>0.05).The biochemical indexes of CR,ALT and CK-MB in the observation group were lower than those in the control group after 24 and 48 hours of treatment,the differences were statistically significant(P<0.05).There was no death in the observation group,and the mortality rate was 0.0%.There were 3 cases of deaths in the control group,and the mortality rate was 27.3%.There was significant difference between the two groups(P<0.05).Conclusion Early continuous blood purification therapy can improve symptoms in patients with heat stroke,and reduce the mortality rate.