摘要
目的回顾性分析老年热射病(EHS)患者并发多器官功能障碍综合征(MODS)的风险因素,筛选预测EHS患者是否并发MODS的评分。方法回顾性分析重庆市三家医院2018年-2023年收治的EHS患者,根据患者器官损伤情况分为MODS组和非MODS组,比较两组患者的临床特征和实验室检查结果差异,采用单因素和多因素Logistic回归分析EHS患者进展MODS的风险因素,ROC曲线评估敏感性和特异性。结果共计167例HS患者中EHS患者101例,MODS占50.5%。MODS组和非MODS组患者在年龄、性别、病程、平均动脉压、伴随症状、热射病类型、中性粒细胞百分比、单核细胞百分比、凝血酶时间、纤维蛋白原、总胆红素和直接胆红素等指标中差异无统计学意义(P>0.05)。MODS组EHS患者的体温、心率、休克比例、急性生理学及慢性健康状况评分(APACHE Ⅱ)、快速序贯器官衰竭评分(qSOFA)和入住ICU比例、住院时间、白细胞计数、中性粒细胞计数、单核细胞计数、中性粒细胞-淋巴细胞比值、凝血酶原时间、活化部分凝血活酶时间、肌酸激酶、肌酸激酶同工酶、肌红蛋白、谷丙转氨酶和谷草转氨酶等指标均高于非MODS组(P<0.05)。单因素Logistic回归分析结果显示,APACHE Ⅱ评分、qSOFA评分、白细胞数量、中性粒细胞数数量、γ-谷氨酰胺转移酶、谷丙转氨酶、谷草转氨酶、肌酸激酶同工酶和乳酸脱氢酶是EHS患者致MODS的危险因素(P<0.05)。多因素Logistic回归分析结果显示,qSOFA评分和APACHE Ⅱ评分是EHS患者进展为MODS的独立危险因素(P<0.05)。结论EHS患者容易发展为MODS,住院时间长,预后差。qSOFA评分和APACHE Ⅱ评分能有效地预测EHS患者进展为MODS。
Objective To explore the risk factors of multiple organ dysfunction syndrome(MODS)in elderly patients with heat stroke(HS)and develop a scoring system for predicting the occurrence of MODS in EHS patients.Methods We conducted a retrospective study of EHS patients,who were admitted to three hospitals in Chongqing from 2018 to 2023.According to their organ injury,all cases were divided into two groups:MODS group and non-MODS group.Various variables,including clinical characteristics and laboratory results were compared between the two groups.Univariate and multivariate Logistic regression analyses were performed to identify the risk factors contributing to the progression of MODS in EHS patients.Additionally,ROC curves were employed to assess the sensitivity and specificity.Results A total of 167 HS patients were included in this study,of whom were beyond 60 years old.And 51 patients developed MODS.There were no significant differences in the age,gender,disease duration,mean arterial pressure,accompanying symptoms,HS type,neutrophil percentage,monocyte percentage,TT,Fib,TBIL,and DBIL(P>0.05)between the MODS and non-MODS groups.However,patients in the MODS group presented with significantly higher values in body temperature,heart rate,shock ratio,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ )score,quick sepsis-related organ failure assessment(qSOFA)score,ICU admission rate,length of hospital stay,white blood cell count,neutrophil count,monocyte count,NLR,PT,APTT,CK,CKMB,myoglobin,ALT,and AST compared to the non-MODS group(P<0.05).Univariate Logistic regression analysis revealed that APACHE Ⅱ score,qSOFA score,white blood cell count,neutrophil count,GGT,ALT,AST,CK-MB,and LDH were risk factors of MODS development in the elderly HS patients(P<0.05).Furtherly,multivariate Logistic regression analysis indicated that qSOFA score and APACHE Ⅱ score were independent risk factors(P<0.05).Conclusion The EHS patients are susceptible to progressing to MODS,compared with long hospital stays and poor prognoses.The qSOFA score and APACHE Ⅱ score are effectively indicators for predicting the progression of MODS in EHS patients.
作者
罗璨
艾山木
曾庆波
马渝
刘梦龙
向云飞
熊丽
阙婉舒
段海真
周法庭
LUO Can;AI Shanmu;ZENG Qingbo;MA Yu;LIU Menglong;XIANG Yunfei;XIONG Li;QUE Wanshu;DUAN Haizhen;ZHOU Fating(Department of Emergency,The Affiliated Hospital of Zunyi Medical University,Zunyi 563000,Guizhou,China;Chongqing Key Laboratory of Emergency Medicine,Chongqing 40010,China;Department of Emergency Medicine,Chongqing Emergency Medical Center,Chongqing University Central Hospital,Chongqing 40010,China)
出处
《西部医学》
2025年第9期1359-1364,共6页
Medical Journal of West China
基金
国家自然科学基金项目(82260385)
重庆市科卫联合重点项目(2024ZDXM024)
重庆市自然科学基金面上项目(CSTB2024NSCQ-MSX0873)
急诊医学重庆市重点实验室开放课题(2023KFKT03)
贵州省科学技术厅,黔科合基础-ZK[2023]一般580号
2023年贵州省卫生健康委科学技术基金(gzwkj2022-103)。
