| Objective:By retrospectively analyzing the clinical data of severe heat stroke patients admitted to the Department of Intensive Care Unit(ICU)in the past 5 years,we explored the independent risk factors that affected the 90-day death early in hospitalization,and futher related the neurological sequelae of surviving patients Subgroup analysis provides reference for clinical treatment.Method:A case-control study was used to retrospectively analyze the clinical data of severe heat stroke patients admitted to the ICU in the Southern Theater General Hospital from April 2014 to May 2019,and collect data on various organ function parameters and treatment measures within 24 hours.90-day risk factors for death,and subgroup analysis was performed in the survival group and the sequelae group according to whether there were neurological sequelae.The comparison of count data uses multiple independent samples of the non-parametric Kruskal-Wallis H test,the comparison of two sets of measurement data uses the non-parametric Mann-Whitney U test,and the comparison of multiple sets of measurement data uses a one-way variance LSD analysis to compare If the distribution is skewed,Kruskal-Wallis H test is used.P<0.05 was considered statistically significant.The survival curve was drawn using Kaplan-Meier method.Adopt single-factor analysis of meaningful indicators,incorporate indicators with P<0.1 into the multi-factor COX regression model,and use forward LR to gradually eliminate,analyze the impact of various indicators on prognosis,and screen prognostic risk factors.Non-parametric method was used to construct ROC curve of each index,calculate area under the cure(AUC),and determine the optimal diagnosis critical point.Result:A total of 117 patients were included,all of whom were male.The age of onset was 9-69 years,and the median age was 21.0(19.0,27.0)years.The ICU hospital stay was 1-49 days,of which the survival group was 8.1 ± 7.1 days,and the median hospital stay was At 5 days,the death group was 11.8±10.6 days,with a median survival time of 9 days.23 patients(19.7%)developed hypotension(MAP<65mmHg);31 patients(26.5%)had unconsciousness duration>24h;14 patients(12%)developed DIC;2 patients died due to central nervous system lesions and 1 patient Liver failure died,and the remaining 10 died of multiple organ dysfunction syndrome.Compared with the survival and death groups,the incidence of hypotension and unconsciousness duration>24h,the time when the core body temperature fell below 38.5℃,heart rate,CT/MRI abnormal rate,organ function indexes were all better,and the incidence of DIC was higher Low(p<0.05);subgroup analysis showed that the cured group was smaller than the sequelae group in terms of age,duration of coma,time when the core body temperature fell below 38.5℃,procalcitonin,and GCS was higher than the latter(p<0.05);Multi-factor COX risk regression model shows cooling time(HR 4.87;95%CI:2.2-15.3;p<0.001),heart rate(HR 1.04;95%CI:1.01-1.09;p=0.02),sequential organ failure The score(HR 1.41;95%CI:1.31-2.02;p<0.001)is an independent risk factor that affects the survival prognosis of patients.The K-M curve showed that the cooling time≤2 h,heart rate≤120 beats/min,and the survival rate of patients with SOFA≤2 points increased significantly,the difference was statistically significant.The area under the ROC curve of the combined cooling time,heart rate,and APACHE II prediction of severe heat stroke death was 98.1%(95%CI 0.957-1.000,p=0.000),sensitivity was 96.2%,and specificity was 92.3%.Conclusion:Compared with the single index,the combined index predicts the best sensitivity and specificity in the prognosis of death 90 days after the onset of severe heat stroke.Taking early comprehensive support measures against organs,shortening the cooling time and the duration of unconsciousness,and slowing the heart rate may reduce the mortality after 90 days after the onset of severe heat stroke.During ICU treatment,heat stroke brain damage involves multiple parts of the center,but the patient’s early CT/MRI imaging abnormalities cannot reflect the degree of brain damage after 90 days. |
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