劳力性热射病的识别与冷却治疗研究进展
摘要
劳力性热射病是一种危及生命的疾病,在进行马拉松等长时间耐力性运动时更容易发生。劳力性热射病发生时还可能伴随有严重的并发症,即时的处置方案经常在患者入院前就开始实施,因此全面了解院前急救冷却治疗方法以及如何更有效地消除潜在并发症的发生显得尤其重要。本文从劳力性热射病流行病学及病理生理学等方面进行综述,进一步明确劳力性热射病从运动现场到急诊部的识别诊断和冷却治疗策略,以期为热射病运动员的急救提供科学依据。
引文
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[2]OConnor FG,Heled Y,Deuster PA.Exertional heat stroke,the return to play decision,and the role of heat tolerance testing:a clinician's dilemma[J].Curr Sport Med Rep,2018,17(7):244-248.
[3]Bouchama A,Dehbi M,Chaves-Carballo E.Cooling and hemodynamic management in heat stroke:practical recommendations[J].Crit Care,2007,11(3):R54.
[4]Robert B,Stonehill.Heat illnesses[J].J Am Coll Emerg Physic,1972,1(6):21-23.
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[9]Yang M,Li Z,Zhao Y,et al.Outcome and risk factors associated with extent of central nervous system injury due to exertional heat stroke[J].Medicine,2017,96(44):e8417.
[10]Belval LN,Casa DJ,Adams WM,et al.Consensus statement-prehospital care of exertional heat stroke[J].Prehosp Emerge Care,2018,22(3):392-397.
[11]Yankelson L,Sadeh B,Gershovitz L,et al.Life threatening events during endurance sports:is heat stroke more prevalent than arrhythmic death?[J].J Am Coll Cardiol,2014,64(5):463-469.
[12]光影体育.2017年国内马拉松第一例猝死:为何防不胜防?[EB/OL].https://baijiahao.baidu.com/s?id=1568898556682532&wfr=spider&for=pc,2017-05-31.
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[14]Grogan H,Hopkins PM.Heat stroke:implications for critical care and anaesthesia[J].Br J Anaesth,2002,88(5):700.
[15]Huisse MG,Pease S,Hurtado-Nedelec M,et al.Leukocyte activation:the link between inflammation and coagulation during heatstroke.A study of patients during the2003 heat wave in Paris[J].Crit Care Med,2008,36(8):2288-2295.
[16]Chen SH,Lin MT,Chang CP.Ischemic and oxidative damage to the hypothalamus may be responsible for heat stroke[J].Curr Neuropharmacolo,2013,11(2):129-140.
[17]Chang CK,Chang CP,Chiu WT,et al.Prevention and repair of circulatory shock and cerebral ischemia/injury by various agents in experimental heatstroke[J].Curr Med Chem,2006,13(26):3145-3154.
[18]Epstein Y,Roberts WO.The pathophysiology of heat stroke:an integrative view of the final common pathway[J].Scand J Med Sci Sports,2011,21(6):742-748.
[19]Stewart TE,Whitford AC.Dangers of prehospital cooling:a case report of afterdrop in a patient with exertional heat stroke[J].J Emerg Med,2015,49(5):630-633.
[20]Wyzewski Z,Gregorczyk KP,Szulc-Dabrowska L,et al.Cooperation between heat shock proteins in organizing of proteins spatial structure[J].Postepy Hig Med Dosw,2014,68(240):793-807.
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[22]Kourtis N,Nikoletopoulou V,Tavernarakis N.Small heat-shock proteins protect from heat-stroke-associated neurodegeneration[J].Nature,2012,490:213-218.
[23]Lopez RM,Tanner P,Irani S,et al.A functional return-to-play progression after exertional heat stroke in a high school football player[J].J Athl Training,2018,53(3):230-239.
[24]Saissy JM,Almanza L,Samuel D,et al.Liver transplantation for fulminant liver failure after exertional heat stroke[J].Press Medical,1996,25(21):977-979.
[25]Kipps C,Sharma S.The incidence of exercise-associated hyponatraemia in the london marathon[J].Br J Sports Med,2011,45(1):14-19.
[26]DeMartini JK,Casa DJ,Belval LN,et al.Environmental conditions and the occurrence of exertional heat illnesses and exertional heat stroke at the falmouth road race[J].J Athl Train,2014,49(4):478-485.
[27]Sherwood SC,Huber M.An adaptability limit to climate change due to heat stress[J].Proc Natl Acad Sci,2010,107(21):9552-9555.
[28]Satirapoj B,Kongthaworn S,Choovichian P,et al.Electrolyte disturbances and risk factors of acute kidney injury patients receiving dialysis in exertional heat stroke[J].Bmc Nephrology,2016,17(1):1-6.
[29]Kerr ZY,Casa DJ,Marshall SW,et al.Epidemiology of exertional heat illness among u.s.high school athletes[J].Am J Prevent Med,2013,44(1):8-14.
[30]Sithinamsuwan P,Piyavechviratana K,Kitthaweesin T,et al.Exertional heatstroke:early recognition and outcome with aggressive combined cooling-a 12-year experience[J].Mil Med,2009,174(5):496-502.
[31]Bedno SA,Li Y,Han W,et al.Exertional heat illness among overweight us rmy recruits in basic training[J].Aviat Space Envir Med 2010,81(2):107-111.
[32]Rav-Acha M,Hadad E,Epstein Y,et al.Fatal exertional heat stroke:a case series[J].Am J Med Sci,2004,328:84-87.
[33]Casa DJ,Guskiewicz KM,Anderson SA,et al.National athletic trainers'association position statement:preventing sudden death in sports[J].J Athl Train,2012,47(1):96-118.
[34]Bouchama A,Dehbi M,Mohamed G,et al.Prognostic factors in heat wave related deaths:a meta-analysis[J].Arch Intern.Med,2007,167(20):2170-2176.
[35]Singh SK,Singh S,Shahbabu B,et al.Managing exertional heat stroke among the combatants[J].J Clinical Diag Res,2017,11(12):OR01-OR04.
[36]Hosokawa Y,Adams WM,Belval LN,et al.Exertional heat illness incidence and on-site medical team preparedness in warm weather[J].Int J Biometeorol,2018,62:1147-1153.
[37]Casa DJ,Armstrong LE,Kenny GP,et al.Exertional heat stroke:new concepts regarding cause and care[J].Curr Sports Med Rep,2012,11(3):115-123.
[38]Chan YK,Mamat M.Management of heat stroke[J].Trends in Anaesthesia and Critical Care,2015,5(2):65-69.
[39]Kimber NE,Ross JJ,Mason SL,et al.Energy balance during an iron triathlon in male and female triathletes[J].Int J Sport Nutr Exerc Metab,2002,12(1):47-62.
[40]Laursen PB.Long distance triathlon:demands,preparation and performance[J].J Hum Sport Exerc,2011,6(2):247-63.
[41]Casa D,Almquist J,Anderson S.Inter-association task force on exertional heat illnesses consensus statement[J].NATA News,2003,6:24-29.
[42]Wade RG,Dziewulski P,Philp BM.The role of an ingestible telemetric thermometer in preventing exertional heat stroke,for a patient with healed massive burns running the 2007 london marathon[J].Burns,2010,36(6):e119-e125.
[43]McDermott BP,Casa DJ,Ganio MS,et al.Acute whole-body cooling for exercise-induced hyperthermia:a systematic review[J].J Athl Train,2009,44(1):84-93.
[44]Casa DJ,McDermott BP,Lee EC,et al.Cold water immersion:the gold standard for exertional heatstroke treatment[J].Exerc Sport Sci Rev,2007,35(3):141-149.
[45]O'Connor JP.Simple and effective method to lower body core temperatures of hyperthermic patients[J].Am JEmerg Med,2017,35(6):881-884.
[46]Wohlfert TM,Miller KC.Does pre-cooling with wholebody immersion affect thermal sensation or perceived exertion?:a critically-appraised topic[J].J Sport Rehabil,2018:1-15.
[47]Gaudio FG,Grissom CK.Cooling methods in heat stroke[J].J Emerg Med,2016,50(4):607-616.
[48]Armstrong L,Casa D,Millard-Stafford M,et al.American college of sports medicine position stand.exertional heat illness during training and competition[J].Med Sci Sports Exerc,2007,39(3):556-572.
[49]Casa DJ,Armstrong LE,Hillman SK,et al.National athletic trainers'association position statement:fluid replacement for athletes[J].J Athl Train,2000,35(2):212-224.
[50]Armstrong LE,Maresh CM.The induction and decay of heat acclimatisation in trained athletes[J].Sports Med,1991,12(5):302-312.
[51]Périard JD.Heat stress and the modern day solider:can we prevent heat illness[J]?J Sci Med Sport,2017,20(2):S97.
[52]Epstein Y,Shapiro Y,Moran D,et al.Use of a heat tolerance test(htt)within the israel defense force(idf)[J].J Sci Med Sport,2017,20:S57-S58.
[53]Schermann H,Heled Y,Fleischmann C,et al.The validity of the heat tolerance test in prediction of recurrent exertional heat illness events[J].J Sci Med Sport,2017,10:1-5.
[2]OConnor FG,Heled Y,Deuster PA.Exertional heat stroke,the return to play decision,and the role of heat tolerance testing:a clinician's dilemma[J].Curr Sport Med Rep,2018,17(7):244-248.
[3]Bouchama A,Dehbi M,Chaves-Carballo E.Cooling and hemodynamic management in heat stroke:practical recommendations[J].Crit Care,2007,11(3):R54.
[4]Robert B,Stonehill.Heat illnesses[J].J Am Coll Emerg Physic,1972,1(6):21-23.
[5]Casa DJ,Demartini JK,Bergeron MF,et al.National athletic trainers’association position statement:exertional heat illnesses[J].J Athl Train,2015,50(9):986-1000.
[6]中华人民共和国卫生部.中华人民共和国国家职业卫生标准GBZ 41-2002职业性中暑诊断标准[S].2002-04-08.
[7]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.
[8]Webber BJ,Pawlak MT,Jones NM,et al.Update heat injuries,active component,u.s.army,navy,air force,and marine corps,2015[J].Med Surveill Mon Rep,2016,23(3):16-19.
[9]Yang M,Li Z,Zhao Y,et al.Outcome and risk factors associated with extent of central nervous system injury due to exertional heat stroke[J].Medicine,2017,96(44):e8417.
[10]Belval LN,Casa DJ,Adams WM,et al.Consensus statement-prehospital care of exertional heat stroke[J].Prehosp Emerge Care,2018,22(3):392-397.
[11]Yankelson L,Sadeh B,Gershovitz L,et al.Life threatening events during endurance sports:is heat stroke more prevalent than arrhythmic death?[J].J Am Coll Cardiol,2014,64(5):463-469.
[12]光影体育.2017年国内马拉松第一例猝死:为何防不胜防?[EB/OL].https://baijiahao.baidu.com/s?id=1568898556682532&wfr=spider&for=pc,2017-05-31.
[13]Leon LR,Helwig BG.Heat stroke:role of the systemic inflammatory response[J].J Appl Physiol,2010,109(6):1980-1988.
[14]Grogan H,Hopkins PM.Heat stroke:implications for critical care and anaesthesia[J].Br J Anaesth,2002,88(5):700.
[15]Huisse MG,Pease S,Hurtado-Nedelec M,et al.Leukocyte activation:the link between inflammation and coagulation during heatstroke.A study of patients during the2003 heat wave in Paris[J].Crit Care Med,2008,36(8):2288-2295.
[16]Chen SH,Lin MT,Chang CP.Ischemic and oxidative damage to the hypothalamus may be responsible for heat stroke[J].Curr Neuropharmacolo,2013,11(2):129-140.
[17]Chang CK,Chang CP,Chiu WT,et al.Prevention and repair of circulatory shock and cerebral ischemia/injury by various agents in experimental heatstroke[J].Curr Med Chem,2006,13(26):3145-3154.
[18]Epstein Y,Roberts WO.The pathophysiology of heat stroke:an integrative view of the final common pathway[J].Scand J Med Sci Sports,2011,21(6):742-748.
[19]Stewart TE,Whitford AC.Dangers of prehospital cooling:a case report of afterdrop in a patient with exertional heat stroke[J].J Emerg Med,2015,49(5):630-633.
[20]Wyzewski Z,Gregorczyk KP,Szulc-Dabrowska L,et al.Cooperation between heat shock proteins in organizing of proteins spatial structure[J].Postepy Hig Med Dosw,2014,68(240):793-807.
[21]Borges TJ,Lopes RL,Pinho NG,et al.Extracellular hsp70 inhibits pro-inflammatory cytokine production by IL-10 driven down-regulation of C/EBPβand C/EBPδ[J].Int J Hyperthermia,2013,29(5):455-463.
[22]Kourtis N,Nikoletopoulou V,Tavernarakis N.Small heat-shock proteins protect from heat-stroke-associated neurodegeneration[J].Nature,2012,490:213-218.
[23]Lopez RM,Tanner P,Irani S,et al.A functional return-to-play progression after exertional heat stroke in a high school football player[J].J Athl Training,2018,53(3):230-239.
[24]Saissy JM,Almanza L,Samuel D,et al.Liver transplantation for fulminant liver failure after exertional heat stroke[J].Press Medical,1996,25(21):977-979.
[25]Kipps C,Sharma S.The incidence of exercise-associated hyponatraemia in the london marathon[J].Br J Sports Med,2011,45(1):14-19.
[26]DeMartini JK,Casa DJ,Belval LN,et al.Environmental conditions and the occurrence of exertional heat illnesses and exertional heat stroke at the falmouth road race[J].J Athl Train,2014,49(4):478-485.
[27]Sherwood SC,Huber M.An adaptability limit to climate change due to heat stress[J].Proc Natl Acad Sci,2010,107(21):9552-9555.
[28]Satirapoj B,Kongthaworn S,Choovichian P,et al.Electrolyte disturbances and risk factors of acute kidney injury patients receiving dialysis in exertional heat stroke[J].Bmc Nephrology,2016,17(1):1-6.
[29]Kerr ZY,Casa DJ,Marshall SW,et al.Epidemiology of exertional heat illness among u.s.high school athletes[J].Am J Prevent Med,2013,44(1):8-14.
[30]Sithinamsuwan P,Piyavechviratana K,Kitthaweesin T,et al.Exertional heatstroke:early recognition and outcome with aggressive combined cooling-a 12-year experience[J].Mil Med,2009,174(5):496-502.
[31]Bedno SA,Li Y,Han W,et al.Exertional heat illness among overweight us rmy recruits in basic training[J].Aviat Space Envir Med 2010,81(2):107-111.
[32]Rav-Acha M,Hadad E,Epstein Y,et al.Fatal exertional heat stroke:a case series[J].Am J Med Sci,2004,328:84-87.
[33]Casa DJ,Guskiewicz KM,Anderson SA,et al.National athletic trainers'association position statement:preventing sudden death in sports[J].J Athl Train,2012,47(1):96-118.
[34]Bouchama A,Dehbi M,Mohamed G,et al.Prognostic factors in heat wave related deaths:a meta-analysis[J].Arch Intern.Med,2007,167(20):2170-2176.
[35]Singh SK,Singh S,Shahbabu B,et al.Managing exertional heat stroke among the combatants[J].J Clinical Diag Res,2017,11(12):OR01-OR04.
[36]Hosokawa Y,Adams WM,Belval LN,et al.Exertional heat illness incidence and on-site medical team preparedness in warm weather[J].Int J Biometeorol,2018,62:1147-1153.
[37]Casa DJ,Armstrong LE,Kenny GP,et al.Exertional heat stroke:new concepts regarding cause and care[J].Curr Sports Med Rep,2012,11(3):115-123.
[38]Chan YK,Mamat M.Management of heat stroke[J].Trends in Anaesthesia and Critical Care,2015,5(2):65-69.
[39]Kimber NE,Ross JJ,Mason SL,et al.Energy balance during an iron triathlon in male and female triathletes[J].Int J Sport Nutr Exerc Metab,2002,12(1):47-62.
[40]Laursen PB.Long distance triathlon:demands,preparation and performance[J].J Hum Sport Exerc,2011,6(2):247-63.
[41]Casa D,Almquist J,Anderson S.Inter-association task force on exertional heat illnesses consensus statement[J].NATA News,2003,6:24-29.
[42]Wade RG,Dziewulski P,Philp BM.The role of an ingestible telemetric thermometer in preventing exertional heat stroke,for a patient with healed massive burns running the 2007 london marathon[J].Burns,2010,36(6):e119-e125.
[43]McDermott BP,Casa DJ,Ganio MS,et al.Acute whole-body cooling for exercise-induced hyperthermia:a systematic review[J].J Athl Train,2009,44(1):84-93.
[44]Casa DJ,McDermott BP,Lee EC,et al.Cold water immersion:the gold standard for exertional heatstroke treatment[J].Exerc Sport Sci Rev,2007,35(3):141-149.
[45]O'Connor JP.Simple and effective method to lower body core temperatures of hyperthermic patients[J].Am JEmerg Med,2017,35(6):881-884.
[46]Wohlfert TM,Miller KC.Does pre-cooling with wholebody immersion affect thermal sensation or perceived exertion?:a critically-appraised topic[J].J Sport Rehabil,2018:1-15.
[47]Gaudio FG,Grissom CK.Cooling methods in heat stroke[J].J Emerg Med,2016,50(4):607-616.
[48]Armstrong L,Casa D,Millard-Stafford M,et al.American college of sports medicine position stand.exertional heat illness during training and competition[J].Med Sci Sports Exerc,2007,39(3):556-572.
[49]Casa DJ,Armstrong LE,Hillman SK,et al.National athletic trainers'association position statement:fluid replacement for athletes[J].J Athl Train,2000,35(2):212-224.
[50]Armstrong LE,Maresh CM.The induction and decay of heat acclimatisation in trained athletes[J].Sports Med,1991,12(5):302-312.
[51]Périard JD.Heat stress and the modern day solider:can we prevent heat illness[J]?J Sci Med Sport,2017,20(2):S97.
[52]Epstein Y,Shapiro Y,Moran D,et al.Use of a heat tolerance test(htt)within the israel defense force(idf)[J].J Sci Med Sport,2017,20:S57-S58.
[53]Schermann H,Heled Y,Fleischmann C,et al.The validity of the heat tolerance test in prediction of recurrent exertional heat illness events[J].J Sci Med Sport,2017,10:1-5.