复方中药治疗大连地区高温引发重症中暑的应用及疗效观察
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摘要
目的探讨复方中药临床治疗高温天气引发重症中暑患者的可行性及临床应用前景。方法选取2018年8月1日至2018年8月12日在大连大学附属中山医院住院治疗的重症中暑患者20例作为研究对象,其中男性13例,女性7例;年龄61～96岁,平均年龄(77. 1±7. 78)岁。采用简单随机法将其分为实验组和对照组,每组10例。对照组进行西医常规对症治疗,实验组在西医常规治疗的基础上加用复方中药水煎剂保留灌肠治疗。比较两组患者高热持续时间(腋下测量法,≥39℃)、体温恢复时间、意识恢复时间(可唤醒并清楚回答问题)、住院时间,同时比较两组患者在治疗过程中发生的主要脏器功能损害情况。结果实验组患者高热持续时间为(1. 6±1. 02) h、体温恢复时间为(10. 6±8. 40) h、意识恢复时间为(1. 87±2. 07) d,平均住院时间为(8. 75±5. 90) d;对照组患者高热持续时间为(5. 83±2. 53) h、体温恢复时间为(20. 78±12. 35) h、意识恢复时间为(7±5. 60) d,平均住院时间为(9. 67±9. 57) d,两组差异均有统计学意义(P均<0. 05)。实验组治疗显效4例,有效3例,无效3例,总有效率为70. 0%;,对照组治疗显效2例,有效3例,无效6例,总有效率为50. 0%,差异有统计学意义(P <0. 05)。实验组肝功指标、MODS及病死率均低于对照组(P <0. 05)。结论依据大连地区高温引发的重症中暑的特点,运用清热生津养阴的白虎汤合增液汤加减。在西医常规治疗的基础上,加用复方中药水煎剂保留灌肠治疗重症中暑,能缩短患者高热持续时间、体温恢复时间、患者意识恢复时间及住院时间,降低主要脏器功能的损害、MODS发生率以及病死率,具有临床应用前景。
Objective Observe and evaluate the methods and effects of clinical treatment for patients with severe heat stroke. Methods 20 patients with severe heat stroke hospitalized in Affiliated Zhongshan Hospital of Dalian were divided into experimental group and control group by simple random method. A prospective randomized controlled trial was performed in 13 males and 7 females,aged 61-96 years,with an average age of( 77. 1 ± 7. 78) years. In the control group,10 patients were treated with Western medicine. In the experimental group,10 patients were treated with compound Chinese herbal medicine decoction retention enema on the basis of routine treatment of Western medicine. The duration of hyperthermia,recovery time of body temperature( Underarm measurement method,body temperature ≥39℃),time of consciousness recovery( can wake up and answer questions clearly),and length of hospital stay were compared between the two groups. The clinical treatment effects of the two groups of patients were evaluated,and the major organ dysfunction occurring during the treatment was compared. Results The therapeutic effect of the experimental group was better than that of the control group. The average duration of hyperthermia in the experimental group was 1. 6 ± 1. 02 h,the mean recovery time was 10. 6 ± 8. 40 h,the average recovery time was 1. 87 ± 2. 07 d,and the average hospital stay was 8. 75 ± 5. 90 d. The average duration of hyperthermia in the control group was 5. 83 ± 2. 53 h,The average recovery time of body temperature was 20. 78 ± 12. 35 h,the average recovery time was 7 ± 5. 60 d,and the average hospital stay was 9. 67 ± 9. 57 d. The difference between the two groups was statistically significant( P < 0. 05). In the experimental group,4 cases were obviously effective,3 cases were effective,3 cases were ineffective,the total effective rate was 70. 0%. In the control group,2 cases were obviously effective,3 cases were effective,6 cases were ineffective,and the total effective rate was 50. 0%. The total effective rate of the treatment group was significantly higher than that of the control group,and the difference was statistically significant( P < 0. 05). The indexes of major organ dysfunction were compared between the two groups. The liver function index,MODS and deaths in the experimental group were lower than those in the control group( P < 0. 05). Conclusion According to the characteristics of severe heatstroke caused by high temperature in Dalian,the traditional Chinese medicine for clearing heat and nourishing yin is used,such as increase or decrease Baihu merged Zengye decoction's medicine. On the basis of routine treatment of Western medicine,the addition of compound Chinese herbal decoction retention enema to treat severe heat stroke can significantly reduce the patient's high fever duration,body temperature recovery time,shorten the patient's consciousness recovery time and hospitalization time,and significantly reduce the damage of major organ function,MODS incidence and mortality. In summary,it has a clinical application prospect.
Objective Observe and evaluate the methods and effects of clinical treatment for patients with severe heat stroke. Methods 20 patients with severe heat stroke hospitalized in Affiliated Zhongshan Hospital of Dalian were divided into experimental group and control group by simple random method. A prospective randomized controlled trial was performed in 13 males and 7 females,aged 61-96 years,with an average age of( 77. 1 ± 7. 78) years. In the control group,10 patients were treated with Western medicine. In the experimental group,10 patients were treated with compound Chinese herbal medicine decoction retention enema on the basis of routine treatment of Western medicine. The duration of hyperthermia,recovery time of body temperature( Underarm measurement method,body temperature ≥39℃),time of consciousness recovery( can wake up and answer questions clearly),and length of hospital stay were compared between the two groups. The clinical treatment effects of the two groups of patients were evaluated,and the major organ dysfunction occurring during the treatment was compared. Results The therapeutic effect of the experimental group was better than that of the control group. The average duration of hyperthermia in the experimental group was 1. 6 ± 1. 02 h,the mean recovery time was 10. 6 ± 8. 40 h,the average recovery time was 1. 87 ± 2. 07 d,and the average hospital stay was 8. 75 ± 5. 90 d. The average duration of hyperthermia in the control group was 5. 83 ± 2. 53 h,The average recovery time of body temperature was 20. 78 ± 12. 35 h,the average recovery time was 7 ± 5. 60 d,and the average hospital stay was 9. 67 ± 9. 57 d. The difference between the two groups was statistically significant( P < 0. 05). In the experimental group,4 cases were obviously effective,3 cases were effective,3 cases were ineffective,the total effective rate was 70. 0%. In the control group,2 cases were obviously effective,3 cases were effective,6 cases were ineffective,and the total effective rate was 50. 0%. The total effective rate of the treatment group was significantly higher than that of the control group,and the difference was statistically significant( P < 0. 05). The indexes of major organ dysfunction were compared between the two groups. The liver function index,MODS and deaths in the experimental group were lower than those in the control group( P < 0. 05). Conclusion According to the characteristics of severe heatstroke caused by high temperature in Dalian,the traditional Chinese medicine for clearing heat and nourishing yin is used,such as increase or decrease Baihu merged Zengye decoction's medicine. On the basis of routine treatment of Western medicine,the addition of compound Chinese herbal decoction retention enema to treat severe heat stroke can significantly reduce the patient's high fever duration,body temperature recovery time,shorten the patient's consciousness recovery time and hospitalization time,and significantly reduce the damage of major organ function,MODS incidence and mortality. In summary,it has a clinical application prospect.
引文
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8 Epstein Y,Roberts WO.The pathopysiology of heatstroke:An integrative view of the final common pathway[J].Scand J Med Sci Sports,2011,21(6):742-48.
9马健,谷晓红,杨宇.温病学[M].2版.上海:上海科学技术出版社,2016:104-110.
10 van Loenhout JAF,Delbiso TD,Kiriliouk A,et al.Heat and emergency room admissions in the Netherlands[J].BMC Public Health,2018,18(1):108.
11 S,Kukec A,Cegnar T,et al.Number of Heat Wave Deaths by Diagnosis,Sex,Age Groups,and Area,in Slovenia,2015 vs.2003[J].Int J Environ Res Public Health,2018,15(1):173.
2谭晓风,丁颖,于晓华.中暑预防的研究进展[J].东南国防医药,2009,11(6):530-533.
3沈洪,刘中民.急诊与灾难医学[M].2版.北京:人民卫生出版社,2013:171-172.
4陈灏珠.实用内科学[M].10版.北京:人民卫生出版社,1998:726.
5 Hifumi T,Kondo Y,Shimizu K,et al.Heat stroke[J].J Intensive Care,2018,6(1):30.
6 Bouchama A,Knochel JP.Heatstroke[J].N Engl J Med,2002,346(25):1978-1988.
7徐昌盛,刘文革.热射病研究进展[J].中华急诊医学杂志,2005,14(7):609-611.
8 Epstein Y,Roberts WO.The pathopysiology of heatstroke:An integrative view of the final common pathway[J].Scand J Med Sci Sports,2011,21(6):742-48.
9马健,谷晓红,杨宇.温病学[M].2版.上海:上海科学技术出版社,2016:104-110.
10 van Loenhout JAF,Delbiso TD,Kiriliouk A,et al.Heat and emergency room admissions in the Netherlands[J].BMC Public Health,2018,18(1):108.
11 S,Kukec A,Cegnar T,et al.Number of Heat Wave Deaths by Diagnosis,Sex,Age Groups,and Area,in Slovenia,2015 vs.2003[J].Int J Environ Res Public Health,2018,15(1):173.