环境热疗后的结果。

Outcomes after environmental hyperthermia.

作者信息

LoVecchio Frank, Pizon Anthony F, Berrett Christopher, Balls Adam

机构信息

Banner Good Samaritan Regional Poison, Phoenix, AZ 85006, USA.

出版信息

Am J Emerg Med. 2007 May;25(4):442-4. doi: 10.1016/j.ajem.2006.11.026.

DOI:10.1016/j.ajem.2006.11.026

PMID:17499664

Abstract

OBJECTIVES

This study was conducted to describe the characteristics and outcomes of patients who presented to the emergency department (ED) with presumed environmental hyperthermia.

METHODS

A retrospective chart review was performed in 2 institutions with patients who were seen in the ED and had a discharge diagnosis of hyperthermia, heat stroke, heat exhaustion, or heat cramps. Exclusion criteria were an alternative diagnosis potentially explaining the hyperthermia (pneumonia, etc). Research assistants, who were blinded to the purpose of the study, performed a systematic chart review after a structured training session. If necessary, a third reviewer acted as a tiebreaker. Data regarding patient demographics, comorbidities, vital signs, laboratory results, and short-term outcome were collected. Data were analyzed with Excel and STATA software.

RESULTS

We enrolled 52 patients with a mean age of 42.6 years (range, 0.4-81 years) from August 1, 2003 to August 31, 2005. The mean high daily temperature was 103.6 degrees F (range, 88-118 degrees F). At presentation, the mean body temperature was 105.1 degrees F (range, 100.2-111.2 degrees F) and the Glasgow Coma Scale score was less than 14 in 36 (69.2%) patients. Laboratory results demonstrated that 21 (40.4%) patients had a creatinine level of more than 1.5 mg/dL, 35 (67.3%) patients had a creatine kinase (CK) of more than 200 U/L, 30 patients (57.7%) had a prothrombin time of more than 13 seconds, 29 (55.8%) patients had an aspartate aminotransferase (AST) of more than 45 U/L, and only 3 patients (5.7%) had a glucose of less than 60 mg/dL. Ethanol or illicit drugs were involved in 18 (34.6%) cases. The mean hospital stay was 4.7 days (range, 1-30 days), and there were 15 deaths (28.8%). A kappa score for interreviewer reliability was 0.69. Major limitations were the retrospective nature and lack of homogeneity in patient evaluation and test ordering.

CONCLUSIONS

Hyperthermic patients with higher initial temperatures, hypotension, or low Glasgow Coma Scale score were more likely to die.

摘要

目的

本研究旨在描述因疑似环境性体温过高而就诊于急诊科（ED）的患者的特征及预后。

方法

对两家机构中在急诊科就诊且出院诊断为体温过高、中暑、热衰竭或热痉挛的患者进行回顾性病历审查。排除标准为可能解释体温过高的其他诊断（如肺炎等）。对研究目的不知情的研究助理在经过结构化培训后进行系统的病历审查。如有必要，由第三位审查员进行裁决。收集患者的人口统计学数据、合并症、生命体征、实验室检查结果及短期预后等数据。使用Excel和STATA软件进行数据分析。

结果

我们纳入了2003年8月1日至2005年8月31日期间的52例患者，平均年龄42.6岁（范围0.4 - 81岁）。每日平均高温为103.6华氏度（范围88 - 118华氏度）。就诊时，平均体温为105.1华氏度（范围100.2 - 111.2华氏度），36例（69.2%）患者格拉斯哥昏迷量表评分低于14分。实验室检查结果显示，21例（40.4%）患者肌酐水平高于1.5mg/dL，35例（67.3%）患者肌酸激酶（CK）高于200U/L，30例（57.7%）患者凝血酶原时间超过13秒，29例（55.8%）患者天门冬氨酸氨基转移酶（AST）高于45U/L，只有3例（5.7%）患者血糖低于60mg/dL。18例（34.6%）病例涉及乙醇或非法药物。平均住院时间为4.7天（范围1 - 30天），有15例死亡（28.8%）。审查员间可靠性的kappa评分为0.69。主要局限性在于研究的回顾性性质以及患者评估和检查项目安排缺乏同质性。