Yang Mengmeng, Li Zhi, Zhao Yan, Zhou Feihu, Zhang Yu, Gao Jingli, Yin Ting, Hu Xin, Mao Zhi, Xiao Jianguo, Wang Li, Liu Chao, Ma Liqiong, Yuan Zhihao, Lv Jianfei, Shen Haoliang, Hou Peter C, Kang Hongjun
Department of Critical Care Medicine, Chinese PLA General Hospital, Beijing Department of Orthopedics, Wuhan General Hospital of Guangzhou Command, Guangzhou Department of Critical Care Medicine, Kai Luan General Hospital, Tangshan Department of Critical Care Medicine, The Centre Hospital of Baotou, Baotou Department of Critical Care Medicine, The 251th Hospital of Chinese PLA, Zhangjiakou Department of Critical Care Medicine, The 180th Hospital of Chinese PLA, Quanzhou Department of Critical Care Medicine, People's Hospital Chang Ji Hui Autonomous Prefecture, Xinjiang Department of Critical Care Medicine, Affiliated Hospital of Nan Tong University, Nantong, China Department of Emergency Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Medicine (Baltimore). 2017 Nov;96(44):e8417. doi: 10.1097/MD.0000000000008417.
To explore the relationship between the extent of central nervous system (CNS) injury and patient outcomes meanwhile research the potential risk factors associated with neurologic sequelae. In this retrospective cohort study, we analyzed data from 117 consecutive patients (86 survivors, 31 nonsurvivors) with exertional heat stroke (EHS) who had been admitted to intensive care unit (ICU) at 48 Chinese hospitals between April 2003 and July 2015. Extent of CNS injury was dichotomized according to Glasgow coma scale (GCS) score (severe 3-8, not severe 9-15). We then assessed differences in hospital mortality based on the extent of CNS injury by comparing 90-day survival time between the patient groups. Exploring the risk factors of neurologic sequelae. The primary outcomewas the 90-day survival ratewhich differed between the 2 groups (P = .023). The incidence of neurologic sequelae was 24.4%. For its risk factors, duration of recurrent hyperthermia (OR = 1.73, 95% CI: 1.20-2.49, P = .003), duration of CNS injury (OR = 1.39, 95% CI: 1.04-1.85, P = .025), and low GCS in the first 24 hours after admission (OR = 2.39, 95% CI: 1.11-5.15, P = .025) were selected by multivariable logistic regression. Cooling effect was eliminated as a factor (OR = 2641.27, 95% CI 0.40-1.73_107, P = .079). Significant differences in 90-day survival ratewere observed based on the extent of CNS injury in patients with EHS, and incidence was 24.4% for neurologic sequelae. Duration of recurrent hyperthermia, duration of CNS injury, and low GCS score in the first 24 hours following admission may be independent risk factors of neurologic sequelae. Cooling effect should be validated in the further studies.
为探讨中枢神经系统（CNS）损伤程度与患者预后之间的关系，同时研究与神经后遗症相关的潜在危险因素。在这项回顾性队列研究中，我们分析了2003年4月至2015年7月期间在中国48家医院重症监护病房（ICU）收治的117例连续性劳力性热射病（EHS）患者的数据（86例幸存者，31例非幸存者）。根据格拉斯哥昏迷量表（GCS）评分将CNS损伤程度分为两类（重度3 - 8分，非重度9 - 15分）。然后，通过比较两组患者的90天生存时间，评估基于CNS损伤程度的医院死亡率差异。探索神经后遗症的危险因素。主要结局是90天生存率，两组之间存在差异（P = 0.023）。神经后遗症的发生率为24.4%。对于其危险因素，复发性高热持续时间（OR = 1.73，95%CI：1.20 - 2.49，P = 0.003）、CNS损伤持续时间（OR = 1.39，95%CI：1.04 - 1.85，P = 0.025）以及入院后最初24小时内GCS评分低（OR = 2.39，95%CI：1.11 - 5.15，P = 0.025）通过多变量逻辑回归被选中。降温效果被排除作为一个因素（OR = 2641.27，95%CI 0.40 - 1.73×107，P = 0.079）。基于EHS患者的CNS损伤程度观察到90天生存率存在显著差异，神经后遗症的发生率为24.4%。复发性高热持续时间、CNS损伤持续时间以及入院后最初24小时内GCS评分低可能是神经后遗症的独立危险因素。降温效果应在进一步研究中得到验证。
