军事训练导致劳力性热射病早期救治策略
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摘要
目的探讨军事训练导致的劳力性热射病早期救治方法。方法方法:回顾分析2015年4月—2018年9月本院收治的35例劳力性热射病的早期救治措施。比较进行集束化治疗后患者体温、器官功能指标及凝血指标的变化。结果除血钾浓度外,与入院时相比,给予集束化治疗后患者出院时的临床指标明显好转:体温降至正常,ALT中位数由入院时的301U/L降至34U/L(p<0.05),Cr中位数由入院时的轻度升高(129μmmol/L)降至正常范围(66μmmol/L)(p<0.001),CK-MB也明显下降(68 vs 18)(p<0.05)。同时,凝血功能得到不同程度改善:PT下降(17.8 vs 13.0)(p<0.05),D-dimer下降(3.48 vs 0.76)(p<0.05),PLT明显上升(115.0×109/L vs 244×109/L)(p<0.05)。收治的35例患者中,33例治愈出院,2例死亡。结论军事训练导致的劳力性热射病患者应给予早期快速降温、早期快速补液、早期快速器官功能支持等集束化治疗,以改善临床症状。此外,早期持续小剂量的抗凝治疗,能够降低弥散性血管内凝血(DIC)的发生率。
Objective To investigate the early treatment of exertion heat stroke(EHS) induced by military training. Methods;The early treatment measures of 35 cases of labor heat stroke admitted to our hospital from April 2015 to September 2018 were retrospectively analyzed. The changes of body temperature, organ function index and coagulation index after cluster therapy were compared.Results:In addition to serum potassium concentration, the clinical indicators of patients discharged from hospital after cluster therapy were significantly improved: body temperature dropped to normal, median ALT decreased from 301 U/L to 34 U/L(p < 0.05), median Cr increased slightly(129 ummol/L) at admission to normal range(66 ummol/L)(p < 0.001), and CK-MB decreased significantly(68 vs 18)(p < 0.05). At the same time, coagulation function was improved in different degrees: PT decreased(17.8 vs 13.0)(p < 0.05), D-dimer decreased(3.48 vs 0.76)(p < 0.05), PLT increased significantly(115.0 *109/L vs 244 *109/L)(p < 0.05). Of the 35 patients admitted, 33 cases were cured and discharged, and 2 cases were died. Conclusion: Patients with exertional heat stroke caused by military training should be given early rapid cooling, early rapid fluid replacement and early rapid organ function support to improve clinical symptoms. In addition, early continuous low dose anticoagulation therapy can reduce the incidence of disseminated intravascular coagulation(DIC).
Objective To investigate the early treatment of exertion heat stroke(EHS) induced by military training. Methods;The early treatment measures of 35 cases of labor heat stroke admitted to our hospital from April 2015 to September 2018 were retrospectively analyzed. The changes of body temperature, organ function index and coagulation index after cluster therapy were compared.Results:In addition to serum potassium concentration, the clinical indicators of patients discharged from hospital after cluster therapy were significantly improved: body temperature dropped to normal, median ALT decreased from 301 U/L to 34 U/L(p < 0.05), median Cr increased slightly(129 ummol/L) at admission to normal range(66 ummol/L)(p < 0.001), and CK-MB decreased significantly(68 vs 18)(p < 0.05). At the same time, coagulation function was improved in different degrees: PT decreased(17.8 vs 13.0)(p < 0.05), D-dimer decreased(3.48 vs 0.76)(p < 0.05), PLT increased significantly(115.0 *109/L vs 244 *109/L)(p < 0.05). Of the 35 patients admitted, 33 cases were cured and discharged, and 2 cases were died. Conclusion: Patients with exertional heat stroke caused by military training should be given early rapid cooling, early rapid fluid replacement and early rapid organ function support to improve clinical symptoms. In addition, early continuous low dose anticoagulation therapy can reduce the incidence of disseminated intravascular coagulation(DIC).
引文
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[11]李玉堂,郭春文,刘辉,等.低分子肝素钠与普通肝素钠治疗劳力性热射病非显性弥散性血管内凝血的比较研究[J].中华危重病急救医学,2015,27(8):649-652.
[2]周新,李风琴,王桂祯.军事训练导致热射病成功救治1例[J].西北国防医学杂志2015,36(11):748
[3]纪筠周飞虎宋青.军事训练导致的劳力性热射病的预防和治疗,中国当代医药2014,21(25):193-196
[4]陈长富,董文鹏,杨博,杨永超,刘莹,王晓武.热射病致器官损伤的研究进展及治疗现状[J]实用医学杂志,2016,32(14):2272-2275.
[5]韩小彤,连续性肾脏替代疗法治疗重症热射病合并多器官功能障碍综合征30例临床分析[J]中国基层医药201118(14):153-154
[6]Bouchama A, Al-Mohanna F, Assad L, et al:Tissue factor/factor‐VIIa pathway mediates coagulation activation in induced-heat stroke in the baboon. Crit Care Med 2012;40:1229-1236.
[7]Huisse MG, Pease S, Hurtado-Nedelec M, et al:Leukocyte activa‐tion:the link between inflammation and coagulation during heat‐stroke. A study of patients during the 2003 heat wave in Paris. Crit Care Med 2008;36:2288-2295.
[8]高铁婴,杨文超,宋青。中暑伴随的凝血功能紊乱[J]中国卫生标准管理20189(20):52-54
[9]全军重症医学专业委员会。热射病规范化诊断与治疗专家共识(草案)[J]解放军医学杂志2015,40(1):1-7
[10]朱红胜,林富禄,刘君,等.达肝素钠治疗热射病并发弥散性血管内凝血疗效观察[J].人民军医,2011,54(9):748-749.
[11]李玉堂,郭春文,刘辉,等.低分子肝素钠与普通肝素钠治疗劳力性热射病非显性弥散性血管内凝血的比较研究[J].中华危重病急救医学,2015,27(8):649-652.