目的：探讨APACHEⅡ及凝血功能指标对劳力性热射病病情及预后判断的意义。方法对沈阳军区总医院自2010年6月至2016年8月救治的48例劳力性热射病患者的临床资料进行回顾性分析。结果本研究共48例患者,32例(66．67%)患者皮肤可见散在出血点；46例(95．83%)存在凝血功能障碍,其中,10例(20．83%)出现弥漫性血管内凝血(DIC)；8例(16．67%)皮肤、鼻、口腔、消化、肺、穿刺部位等发生出血。全部48例患者均发生多器官功能衰竭,其中,3个器官受累2例,4个器官受累10例,5个器官受累16例,5个以上器官受累20例。死亡者APACHE Ⅱ评分高于生存者( P<0．05),且两组血小板及凝血功能指标(活化部分凝血酶时问、凝血酶原时间、纤维蛋白原)比较,差异均有统计学意义( P<0．05)。结论 APACHE Ⅱ评分及凝血指标的变化与热射病的病情严重程度及预后密切相关。%Objective To explore the value of APACHE Ⅱ and coagulation indexes to exertional heat stroke( EHS) condi-tion and prognosis. Methods A retrospective study was performed for analyzing the record of 48 EHS patients treated in our hospital from June 2010 to August 2016. Results During the course,32 cases suffered from visible hemorrhagic spots on skin. Forty-six cases(95. 83%)were with coagulation disorders,and ten case(20. 83%)showed disseminated intravascu-lar coagulation(DIC). Eight cases(16. 67%)bled in skin,noses,mouths,digestive,lungs and punctured parts. Multiple or-gan failure appeared within all 48 cases,2 cases involved 3 organs,10 cases involved 4 organs,16 cases involved 5 organs, and 20 cases involved more than 5 organs. The scores of acute physiology and chronic health evaluation of death group were higher than survivor group(P<0. 05). The differences of platelets and coagulation indexes(activated partial thrombin time, prothrombin time and fibrinogen)were statistically significant(P<0. 05). Conclusion The changes of APACHE Ⅱ and coagulation indexes are closely related to the severity of the case and prognosis.
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