老年劳力性热射病患者的临床特点及预后

Clinical Characteristics and Prognosis of Exertional Heat Stroke in Elderly Patients

目的探讨老年劳力性热射病(EHS)患者的临床特点及预后。方法回顾性分析2015年1月至2022年12月收治的9例老年EHS患者(观察组)与24例年轻EHS患者(对照组)的临床资料。记录2组患者住院天数、核心体温;检测2组血常规、生化指标;观察2组并发症发生情况;分析老年EHS患者临床特点及预后转归,并评价血液净化对EHS患者的治疗作用。结果入院时观察组患者血脑钠肽高于对照组,血肌酐、白蛋白及血小板低于对照组(P<0.05,P<0.01);2组血尿素氮、肌酸肌酶、乳酸脱氢酶、淀粉酶、丙氨酸转氨酶、肌红蛋白、白细胞水平比较差异无统计学意义(P>0.05)。观察组患者合并横纹肌溶解、肝功能损伤、心功能不全、低蛋白血症、感染的比例均显著高于对照组(P<0.05,P<0.01)。出院时,观察组乳酸脱氢酶、丙氨酸转氨酶、肌红蛋白低于入院时,血白蛋白低于正常值;观察组血乳酸脱氢酶、白细胞水平高于对照组,血肌酐、白蛋白水平低于对照组(P<0.05,P<0.01)。2组患者中各有3例行介入肾替代治疗,出院时肾功能指标均正常。2组住院时间比较差异无统计学意义(P>0.05);出院时对照组痊愈患者比例显著高于观察组(P<0.05)。结论老年EHS患者易合并横纹肌溶解、肝功能损伤、心功能不全、低蛋白血症、感染等并发症,肌肉损伤、肝功能损伤与营养恢复较年轻患者慢,合并急性肾损伤与多器官功能障碍综合征的EHS重症患者应依据病情早期介入肾替代治疗,发挥协同治疗作用,有利于改善预后,提高抢救成功率。

Objective To investigate the clinical characteristics and prognosis of elderly patients with exertional heat stroke(EHS).Methods The clinical data of 9 elderly patients with EHS treated from January 2015 to December 2022 were retrospectively analyzed as observation group and 24 young patients with EHS served as control group.Hospitalization days and core body temperature were recorded in the two groups,and blood routine and biochemical indexes of the two groups were detected.The occurrence of complications in the two groups was observed.The clinical characteristics and prognosis of elderly patients with EHS were analyzed and compared,and the therapeutic effect of blood purification on patients with EHS was evaluated.Results Serum B-type natriuretic peptide precursor in observation group was higher than that in control group at admission,while serum creatinine,albumin and platelet were lower than those in control group(P<0.05,P<0.01).There was no significant difference in the levels of blood urea nitrogen,creatine kinase,lactate dehydrogenase(LDH),amylase,alanine aminotransferase(ALT),myoglobin,and white blood cells(WBC)between the two groups(P>0.05).The proportions of rhabdomyolysis,liver function impairment,cardiac insufficiency,hypoproteinemia and infection in observation group were significantly higher than those in control group(P<0.05,P<0.01).At discharge,LDH,ALT,and myoglobin levels in the observation group were lower than those at admission,and the blood albumin levels were lower than norma;the levels of LDH and WBC in the observation group were higher than those in the control group,while the levels of creatinine and blood albumin were lower than those in the control group(P<0.05,P<0.01).Three patients in each group were treated with renal replacement therapy(RRT),and renal function indexes were normal at discharge.There was no significant difference in length of hospital stay between the two groups(P>0.05).The proportion of cured patients in control group was significantly higher than that in observation group at discharge(P<0.05).Conclusion Elderly EHS patients are prone to complications such as rhabdomyolysis,liver function impairment,cardiac insufficiency,hypoproteinemia,and infection.Recovery from muscle injury and liver function impairment and nutritional recovery are slower than those of young patients.Severe EHS patients complicated with acute kidney injury and multiple organ dysfunction syndrome should be treated with RRT early according to their condition to play a synergistic therapeutic effect,which is beneficial to improvement of prognosis and increase in the success rate of rescue.