Li Qinghua, Song Qing, Sun Rongqing, Lyu Hongdi, Wang Nannan, Wang Haiwei, Qin Wenqi, Hu Qing, Jiao Yunlai, Yan Jin, Zhang Senlin, Wang Jing, Li Xinli
Department of Intensive Care Unit, the 159th Hospital of PLA, Zhumadian 463008, Henan, China (Li QH, Lyu HD, Wang NN, Wang HW, Hu Q, Yan J, Zhang SL, Wang J, Li XL); Department of Intensive Care Unit, General Hospital of the Liberation Army, Beijing 100853, China (Song Q); Department of Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China (Sun RQ); 72506 Army Health Team of Central War Zone, Queshan 463008, Henan, China (Qin WQ); 83th Team of Shaanxi Lintong 71897 Army, Xi'an 710600, Shaanxi, China (Jiao YL). Corresponding author: Song Qing, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018 Jul;30(7):681-685. doi: 10.3760/cma.j.issn.2095-4352.2018.07.013.
To explore the relationship between physiological parameters changes and severe heatstroke induced by 5-km armed cross-country training.
A total of 521 male officers and soldiers from a special team who participated in the summer training of 5-km armed cross-country training from year 2016 to 2017 were enrolled. All trainees participated in 5-km armed cross-country training in high temperature and humidity environment of ambient temperature > 32 centigradeand (or) relative humidity > 65%. The trainees were divided into two groups according to the incidence of severe heatstroke in the course of training. The age, enlistment time, constitution score, body mass index (BMI), external environment (ambient temperature, relative humidity, wind speed, heat index) of trainees of the two groups, and the change rates of arterial blood oxygen saturation (SaO), body temperature, pulse and blood pressure within 5 minutes after the 5-km armed cross-country training were compared between the two groups. The risk factors of severe heatstroke were screened by two classified Logistic regression analysis, and the predictive value of various risk factors of severe heatstroke was analyzed by the receiver operator characteristic curve (ROC).
In 521 trainees of 5-km armed cross-country training, 29 trainees suffered from severe heatstroke accounting for 5.57%. There was no significant difference in the age, enlistment time, constitution score, BMI, or external environment during 5-km armed cross-country training between severe heatstroke group and non-severe heatstroke group. Compared with those without severe heatstroke, the descending rates of body temperature, pulse, blood pressure and SaO increased rate within 5 minutes after 5-km armed cross-country training of severe heatstroke trainees were significantly decreased [temperature descending rate: (0.67±0.30)% vs. (1.43±1.28)%, pulse descending rate: (7.53±5.21)% vs. (13.48±8.07)%, blood pressure descending rate: (9.28±6.84)% vs. (19.42±7.73)%, SaO increased rate: (0.51±0.39)% vs. (1.50±1.43)%, all P < 0.01]. Two classification Logistic regression analysis showed that the temperature descending rate [odds ratio (OR) = 0.485, 95% confidence interval (95%CI) = 0.289-0.817], pulse descending rate (OR = 0.903, 95%CI = 0.845-0.965), blood pressure descending rate (OR = 0.841, 95%CI = 0.790-0.896), and SaO2 increased rate (OR = 0.421, 95%CI = 0.250-0.711) were the risk factors for severe heatstroke during 5-km armed cross-country training (all P < 0.01). ROC curve analysis showed that temperature descending rate [area under ROC curve (AUC) = 0.659, 95%CI = 0.604-0.714], pulse descending rate (AUC = 0.730, 95%CI = 0.762-0.900), blood pressure descending rate (AUC = 0.831, 95%CI = 0.659-0.801), SaO increased rate (AUC = 0.711, 95%CI = 0.655-0.767) could be used for the incidence of severe heatstroke prediction during 5-km armed cross-country training (all P < 0.01), and the predicted value was the same.
Under the same conditions, the severe heatstroke during 5-km cross-country training is closely related to the descending rates of body temperature, pulse, and blood pressure as well as SaO increased rate within 5 minutes after the training, whose predictive values for severe heatstroke were the same.
探讨5公里武装越野训练诱发重症中暑时生理参数变化特点及相互关系。
选取2016年至2017年参加夏季5公里武装越野训练的某特战旅男性官兵521名,均在环境温度>32℃和(或)相对湿度>65%的高温高湿环境下完成5公里武装越野训练,依据训练中重症中暑发生情况分为中暑组和非中暑组。比较两组年龄、入伍时间、体质评分、体重指数(BMI)、训练时外界环境(气温、相对湿度、风速、热指数)及5公里武装越野训练结束后5分钟内动脉血氧饱和度(SaO)、体温、脉搏、血压变化率。采用二分类Logistic回归分析筛选重症中暑的危险因素,并绘制受试者工作特征曲线(ROC)分析各危险因素对重症中暑的预测价值。
521名参加5公里武装越野训练人员中,发生重症中暑29例,发生率为5.57%。中暑组与非中暑组年龄、入伍时间、体质评分、BMI、训练时外界环境比较,差异均无统计学意义。与未发生重症中暑人员比较,中暑人员5公里武装越野训练结束后5分钟内体温下降率、脉搏下降率、血压下降率及SaO上升率均明显降低[体温下降率:(0.67±0.30)%比(1.43±1.28)%,脉搏下降率:(7.53±5.21)%比(13.48±8.07)%,血压下降率:(9.28±6.84)%比(19.42±7.73)%,SaO上升率:(0.51±0.39)%比(1.50±1.43)%,均P<0.01]。二分类Logistic回归分析显示,体温下降率[比值比(OR)=0.485,95%可信区间(95%CI)=0.2890.817]、脉搏下降率(OR=0.903,95%CI=0.8450.965)、血压下降率(OR=0.841,95%CI=0.7900.896)及SaO上升率(OR=0.421,95%CI=0.2500.711)是5公里武装越野训练过程中重症中暑的危险因素(均P<0.01)。ROC曲线分析显示,体温下降率[ROC曲线下面积(AUC)=0.659,95%CI=0.6040.714]、脉搏下降率(AUC=0.730,95%CI=0.6720.900)、血压下降率(AUC=0.831,95%CI=0.7800.896)及SaO上升率(AUC=0.711,95%CI=0.6550.767)对5公里武装越野训练过程中重症中暑均有预测价值(均P<0.01),且预测价值相同。
同等条件下,5公里武装越野训练过程中发生重症中暑与训练结束后5分钟内体温、脉搏、血压下降率及SaO上升率密切相关,且对重症中暑的预测价值相同。