Analysis About The Influencing Factors Of Prognosis In Severe Heatstroke Patients With Bundle Treatment

Objective:Research about the general condition, clinical data,"bundle treatment" completion status and prognosis in severe heatstroke patients, analysis about the influencing factors of prognosis, estimate the influence of "bundle treatment" on prognosis, in order to provide the scientific basis for treatment of patients with severe heatstroke.Methods:Record the general condition, clinical data,"bundle treatment" completion status and prognosis of72severe heatstroke patients in Hunan Qiyang People’s Hospital from July2009to July2013, then use EpiData and SPSS17.0to entry and analyze all data, the analysis methods were descriptive statistics, t test and x2test, logistic regression.Results:①In72severe heatstroke patients, male to female ratio was4.1:1, the average age was (45.6±10.9) years old, the occupation were farmers (44.4%), workers (43.1%) and driver (4.2%);②In72severe heatstroke patients, the average temperature was (40.2±1.3)℃, heart rate was (111.6±18.6) beats/min, respiratory frequency was (28.8±3.7) beats/min, blood pressure was (108.2±21.4/70.6±13.3) mmHg, oxygen saturation was (82.8±8.9)%,37.5%people appeared in the shock, the average white blood cell count was (11.8±2.5) x109/L, the platelet count was (130.0±40.0)×109/L, hematocrit was (42.6±4.3)%, the average blood glucose was (5.4±1.2) mmol/L, alanine aminotransferase was (114.7±70.7) u/L, aspartate aminotransferase was (95.2±61.8) u/L, urea nitrogen was (6.1±1.6) mmol/L, creatinine was (85.4±31.9) μmoI/L, serum potassium concentration was (4.1±0.8) mmol/L, blood sodium concentration was (117.4±14.3) mmol/L, prothrombin time was (25.1±10.6) seconds, activated partial thromboplastin time was (36.6±6.3) seconds;(③In72severe heatstroke patients, the average score of GCS was10.6±2.6, among them, mildcoma patients accounted for11.1%, moderate coma patients accounted for63.9%and severe coma patients accounted for25%, the average score of APACHE Ⅱ was16.2±7.7,33.3%patients were lower than10score,31.9%patients were10to20score, and34.7%patients were higher than20score;④In72severe heatstroke patients,59.7%of them have completed6hours "bundle treatment",66.7%of them have completed24hours "bundle treatment", the completed of "Contral the temperature early","Contral the CVP、 ScvO2and urine volume in patients with hypotension"," Control the blood glucose in8.3mmol/L " were poor, which complete rate were59.7%、59.5%and58.7%, the completed rate of6h and24h "bundle treatment" were rising with the year ahead;⑤In72severe heatstroke patients, the mortality rate was40.3%, patients who had basic diseases, longer treatment time, with shock, higher APACHE Ⅱ score, higher body temperature, faster heart and breathing rate, higher white blood cells and blood urea nitrogen, longer prothrombin time and activated partial thromboplastin time, the prognosis were poorer (P<0.05), the OR values were1.43,30.60,5.18,47.47,1.38,1.49,1.47,5.17,5.31,15.35,15.49, patients who had higher GCS score, blood oxygen saturation and platelet, the prognosis were better (P<0.05), the OR values were0.12,0.60,0.20, patients who had completed the6h bundle or24h "bundle treatment", the prognosis were better (P<0.05), the OR values were0.18,0.62. Conclusion:①The influencing factors of prognosis in severe heatstroke patients were basic diseases, treatment time, shock, GCS score, APACHE Ⅱ score, the completion of6h and24h "bundle treatment", the patient’s temperature, heart rate, respiration, blood oxygen saturation, white blood cells, platelets, blood urea nitrogen, prothrombin time and activated partial thromboplastin time, among them, GCS score, blood oxygen saturationblood urea nitrogen, the completion of6h and24h "bundle treatmen"were protect factors, and others were dangerous factors;②The completion of "bundle treatment" could improve the prognosis in patients with severe heatstroke, we should advance the compliance of "bundle treatment" and standardize them based on the affecting factors.