Cheng L, Liu D L, Wang M N, Yin X X, Liu Y, Liu W, Zhang Q F, Ye G
Emergent Intensive Care Unit, Beijing Luhe Hospital. Capital Medical University, Beijing 101100, China.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2021 Jan 20;39(1):29-32. doi: 10.3760/cma.j.cn121094-20200114-00028.
To explore the risk factors of acute renal injury (AKI) in exertional heat radiation disease (EHS) . In november 2019, the clinical data of 69 EHS patients admitted from July 2015 to September 2019 were reviewed. The general data, laboratory indexes, Glasgow score (GCS) at admission, 24-hour acute physiology and chronic health score Ⅱ (APACHE Ⅱ) , exposure time rate and physical labor intensity were collected. According to the occurrence of AKI, the patients were divided into AKI group and non-AKI group, 31 and 38 in each group. The differences of general data and laboratory indexes between the two groups were compared, and the t and Mann-Whitney U test were used to compare the two groups. The enumeration data are expressed by examples and constituent ratio (%) . Independent sample χ(2) test is used for inter-group comparison, and multiple test is used for multi-sample comparison. The correlation was analyzed by linear regression. Risk factors were analyzed by Logistic regression analysis. At discharge, 31 of 69 EHS patients developed AKI. Compared with the non-AKI group, the heart rate, white blood cell count, lactic acid, D-dimer and myoglobin were higher; MAP, platelet count and PH were lower in the AKI group. The difference was statistically significant (<0.05) . APACHE Ⅱ score, core temperature, time to drop to 38.5 ℃, contact time rate, platelet count, pH, lactic acid, D-dimer and myoglobin were all correlated with creatinine (=0.57, 0.42, 0.80, 0.78, 0.57, 0.43, 0.51, 0.55, 0.79) . APACHE Ⅱ score, time to drop to 38.5C, Lac and MYO are the risk factors of AKI in EHS patients. Multivariate Logistic regression analysis showed that the time required to drop to 38.5C was an independent risk factor for the occurrence of AKI. AKI is a serious complication of EHS. EHS complicated with AKI, should be identified early and effective intervention measures should be taken.
探讨劳力性热射病（EHS）患者发生急性肾损伤（AKI）的危险因素。回顾性分析2015年7月至2019年9月收治的69例EHS患者的临床资料。收集患者的一般资料、实验室指标、入院时格拉斯哥昏迷评分（GCS）、24小时急性生理与慢性健康状况评分Ⅱ（APACHEⅡ）、暴露时间率及体力劳动强度。根据是否发生AKI将患者分为AKI组和非AKI组，每组31例和38例。比较两组患者的一般资料和实验室指标差异，采用t检验和Mann-Whitney U检验进行组间比较。计数资料以例数和构成比（%）表示，组间比较采用独立样本χ²检验，多样本比较采用多重检验。采用线性回归分析相关性，Logistic回归分析危险因素。69例EHS患者出院时，31例发生AKI。与非AKI组比较，AKI组心率、白细胞计数、乳酸、D-二聚体及肌红蛋白升高；平均动脉压（MAP）、血小板计数及pH值降低。差异有统计学意义（<0.05）。APACHEⅡ评分、核心体温、降至38.5℃时间、接触时间率、血小板计数、pH值、乳酸、D-二聚体及肌红蛋白均与肌酐相关（r=0.57、0.42、0.80、0.78、0.57、0.43、0.51、0.55、0.79）。APACHEⅡ评分、降至38.5℃时间、乳酸及肌红蛋白是EHS患者发生AKI的危险因素。多因素Logistic回归分析显示，降至38.5℃所需时间是AKI发生的独立危险因素。AKI是EHS的严重并发症，EHS合并AKI时应早期识别并采取有效干预措施。
