热射病的临床特征及死亡危险因素分析

Clinical characteristics and mortality risk factors analysis of heat stroke

目的回顾性分析热射病(heat stroke,HS)及HS相关急性肾损伤(acute kidney injury,AKI)的临床特征,分析导致患者死亡危险因素,为HS的防治提供新的思路。方法回顾性选择2019年7月-2023年9月于四川亚热带季风气候、HS高发地区的13家医院就诊的HS患者。根据是否发生院内死亡、AKI,将患者分为存活组和死亡组,AKI组和非AKI组。并根据血清肌酐水平,将AKI组患者分为AKI 1期组、AKI 2期组和AKI 3期组。分析患者的主要临床表现、重要临床数据,并通过多因素logistic回归分析影响患者死亡的危险因素。结果共纳入HS患者195例,HS相关AKI患者115例。多因素logistic回归分析结果显示,AKI、凝血功能异常、神经系统损伤、中性粒细胞/淋巴细胞比值、D-二聚体是死亡的独立危险因素(P<0.05)。HS相关AKI临床特征分析结果显示,AKI 2期和AKI 3期患者的死亡率较高(P<0.05)。结论AKI、凝血功能异常、神经系统损伤、中性粒细胞/淋巴细胞比值、D-二聚体是HS发生死亡独立危险因素。因此,未来对于HS合并AKI、凝血功能异常、神经系统损伤患者的积极治疗有利于减低患者死亡风险。

Objective To retrospectively analyze the clinical characteristics of heat stroke(HS)and HS-acute kidney injury(AKI),analyze the risk factors leading to death in patients,and provide new ideas for the prevention and treatment of HS.Methods Patients with HS who visited 13 hospitals in Sichuan subtropical monsoon climate and HS high-incidence areas between July 2019 and September 2023 were retrospectively selected.According to whether in-hospital death or AKI occurred,the patients were divided into survival group and death group,AKI group and non-AKI group.According to serum creatinine level,patients in the AKI group were divided into AKI stage 1 group,AKI stage 2 group and AKI stage 3 group.The main clinical manifestations and important clinical data of the patients were analyzed,and the risk factors affecting the death of patients were analyzed by multivariate logistic regression.Results A total of 195 patients with HS and 115 patients with HS-AKI were included.The results of multivariate logistic regression analysis showed that AKI,abnormal coagulation function,nervous system injury,neutrophil/lymphocyte ratio,and D-dimer were independent risk factors for death(P<0.05).The results of clinical characteristics analysis of HS-AKI showed that the mortality rate of patients with AKI stage 2 and AKI stage 3 was higher(P<0.05).Conclusions S AKI,abnormal coagulation function,nervous system injury,neutrophil/lymphocyte ratio,and D-dimer are independent risk factors for death in HS.Therefore,active treatment of patients with HS combined with AKI,abnormal coagulation function,and nervous system injury in the future will help reduce the risk of death in patients.