静脉降温结合营养支持在热射病急救中的应用

Application of intravenous cooling and nutritional support in the emergency treatment of heat shot disease

目的探讨静脉降温结合营养支持在热射病急救中的应用效果。方法选取2017年9月至2019年8月空军军医大学第一附属医院急诊科收治的热射病患者50例的资料进行回顾性分析,通过患者所采用的救治方法将2组患者分为对照组和观察组,每组均为25例。对照组予以常规热射病急救处理,观察组在对照组基础上予以静脉降温以及早期肠内外营养支持治疗。比较2组的体温下降至38℃时间、机械通气时间、营养状态、平均住院时间、不良反应发生情况、28 d病死率。结果观察组的体温下降至38℃时间、机械通气时间、平均住院时间、治疗10 d的急性生理学及慢性健康状况评分(APACHEⅡ)分别为(2.55±0.63)h、(6.34±1.36)d、(7.34±1.87)d、(15.83±2.88)分,均低于对照组的(3.36±0.58)h、(7.87±1.97)d、(8.65±2.39)d、(18.37±3.27)分,差异有统计学意义(t值为2.580~4.729,P<0.05);治疗后10 d,观察组的血清血红蛋白(Hb)、白蛋白(ALB)、前白蛋白(PAB)水平分别为(145.77±29.54)、(38.77±3.19)、(146.56±4.52)g/L,均高于对照组的(123.59±20.21)、(33.27±3.28)、(110.84±4.30)g/L,差异有统计学意义(t值为-3.098、-6.010、-31.913,P<0.01);治疗期间2组所出现的各个单项不良反应发生率差异均不具有统计学意义(P>0.05),对照组出现不良反应比例为44.00%(11/25),28 d病死率为24.00%(6/25),均高于观察组的16.00%(4/25)和0(χ2值为4.667、4.735,P<0.05)。结论对热射病患者予以常规急救管理的基础上同时结合静脉降温和早期肠内外营养支持治疗,能够快速降低患者体温,改善机体营养状态,有利于促进患者预后并降低病死率,值得临床上广泛推广。

Objective To investigate the effect of venous cooling and nutritional support in the treatment of heat stroke.Methods A retrospective analysis was performed on 50 cases of patients with heat-radiated disease admitted to the Emergency Department of the First Affiliated Hospital of the PLA Military Medical University from September 2017 to August 2019.The two groups of patients were divided into the control group and the observation group by the rescue method adopted by the patients,and each group had 25 cases.The control group was given routine heat treatment for emergency treatment,and the observation group was given intravenous cooling and early enteral and parenteral nutrition support treatment based on the control group.The time of body temperature drop to 38℃,mechanical ventilation time,nutritional status,average hospitalization time,occurrence of adverse reactions,and 28-day mortality were compared between the two groups.Results The temperature of the observation group decreased to 38℃,the time of mechanical ventilation,the average length of hospital stay,and the Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score after 10 days of treatment were(2.55±0.63)hours,(6.34±1.36)days,(7.34±1.87)days,(15.83±2.88)points,which were significantly lower than(3.36±0.58)hours,(7.87±1.97)days,(8.65±2.39)days,(18.37±3.27)points of the control group(t values were 2.580-4.729,all P<0.05);10 days of treatment,the serum Hemoglobin(Hb),Albumin(ALB),and prealbumin(PAB)in the observation group were(145.77±29.54),(38.77±3.19),(146.56±4.52)g/L,which were higher than(123.59±20.21),(33.27±3.28),(110.84±4.30)g/L in the control group(t values were-3.098,-6.010,-31.913,P<0.01).There was no statistically significant difference in each individual adverse event occurred in the two groups during treatment in response rate data(P>0.05).The proportion of adverse reactions was 44.00%(11/25)and 28-day mortality was 24.00%(6/25)in the control group were higher than 16.00%(4/25)and 0 in the observation group(χ2 values were 4.667,4.735,P<0.05).Conclusions On the basis of routine emergency management,combined with intravenous cooling and early enteral and parenteral nutrition support treatment,it can rapidly reduce the temperature of patients,improve the nutritional status of the body,promote the prognosis of patients and reduce the mortality,which is worth popularizing in clinical practice.