Effect of cerebral edema on multiple organ dysfunction in patients with exertional heat stroke / 中国中西医结合急救杂志

ABSTRACT

Objective To observe the relationship between different degree of cerebral edema and multiple organ dysfunction syndrome (MODS) of exertional heat stroke (EHS) patients. Methods The patients with EHS admitted to intensive care unit (ICU) of the 159th Hospital of PLA from June 2015 to June 2017 were enrolled. The electrical impedance perturbation coefficient (EIDC) of bilateral cerebral hemispheres were monitored at 2, 24 and 72 hours after the onset of the disease by BORN-BE non-invasive dynamic cerebral edema monitor, and the patients were divided into 9+ group, 10+ group and 11+ group according to the resistance of the measured mean impedance coefficients. Fasting venous blood of the patients were acquired after 2 hours and 72 hours of the disease, the levels of serum interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), nitric oxide (NO), nitric oxide synthase (NOS), cardiac troponin I (cTnI), MB isoenzyme of creatine kinase (CK-MB), creatinine (Cr), β2-microglobulin (β2-MG), alanine aminotransferase (ALT) and aspartate transaminase (AST) were detected. The occurrence of MODS within 72 hours was recorded. Linear regression analysis of the correlation between EIDC and MODS was done. Results All 124 EHS patients were male; the age was (22.10±4.43) years. Among them, 20 in EIDC 9+ group, 61 in 10+ group, and 43 in 11+ group. There were no significant differences in the levels of IL-1β, TNF-α, NO, NOS, cTnI, CK-MB, Cr, β2-MG, ALT, AST after onset of 2 hours among different EPIC groups; all the indexes of 72 hours were significantly higher than those of 2 hours in each group; and the higher the EIDC, the more obvious increase of each index [EIDC 9+ group, 10+ group, 11+ group at 72 hours IL-1β (ng/L) 12.05±3.75, 18.49±7.94, 23.21±10.44;TNF-α (ng/L) 13.10±3.18, 18.92±7.23, 23.40±10.17; NO (μmol/L) 99.50±12.10, 111.41±17.75, 120.81±15.58;NOS (kU/L) 47.95±8.33, 56.70±12.12, 63.37±12.60; cTnI (ng/L) 92.75±20.92, 107.20±18.96, 117.30±14.53;CK-MB (U/L) 73.55±9.25, 83.23±13.19, 93.49±12.25; Cr (μmol/L) 165.30±9.41, 176.62±9.83, 180.09±10.14;β2-MG (mg/L) 16.45±2.68, 19.07±3.68, 22.05±3.93; ALT (U/L) 500.10±87.05, 563.90±91.28, 612.16±90.61, AST (U/L) 414.30±53.35, 470.51±73.83, 512.09±81.29, respectively, two-two comparison all P ＜ 0.05], the higher of the MODS incidence [40.00 % (8/20), 65.57% (40/61), 83.72% (36/43), x2= 12.199, P = 0.002]. Linear regression analysis showed that the degree of cerebral edema was positively correlated with the incidence of MODS (R2= 0.905, P = 0.002). Conclusion The higher of the EIDC, the more severe of cerebral edema, the stronger of the inflammatory reaction, and the more severe damage of heart, liver, kidney and other organs in EHS patients within 72 hours.