热射病相关弥散性血管内凝血的研究进展
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摘要
热射病是一种致命的中暑,是临床上需要紧急救治的危急症。其高死亡率可能与热细胞毒性、凝血功能紊乱、肠道继发感染、全身炎症反应综合征及多器官功能衰竭等各种复杂的临床特征相互作用有关。其中,热射病相关的凝血功能障碍,特别是弥散性血管内凝血(DIC),是导致患者多器官功能衰竭,甚至死亡的重要原因之一。热射病相关的DIC的发病机制尚不明确,其检测指标和治疗缺乏精确性,因而导致病死率居高不下。未来,临床应早期精准地检测,及时纠正凝血功能障碍,重建凝血-抗凝系统平衡,减轻全身炎症反应,阻止器官功能进一步恶化,以改善热射病合并的DIC的预后。
Heat stroke is a fatal disease,which needs urgent treatment in clinical. Its high mortality may be related to the interaction of various complex clinical features such as thermal cytotoxicity,coagulopathy,secondary intestinal infection,systemic inflammatory response syndrome,and multiple organ failure. Among them,coagulation dysfunction associated with heat stroke,especially disseminated intravascular coagulation( DIC),is one of the important causes of multiple organ failure and even death in patients. The pathogenesis of DIC related to heat stroke is still unclear,and its detection index and treatment lack of precision,which leads to a high mortality rate. In the future,clinical examination should be carried out early and accurately,timely correction of coagulation dysfunction,reconstruction of coagulation-anticoagulation system balance,reduction of systemic inflammatory response to prevent further deterioration of organ function should be done,so as to improve the prognosis of DIC in heat stroke patients.
Heat stroke is a fatal disease,which needs urgent treatment in clinical. Its high mortality may be related to the interaction of various complex clinical features such as thermal cytotoxicity,coagulopathy,secondary intestinal infection,systemic inflammatory response syndrome,and multiple organ failure. Among them,coagulation dysfunction associated with heat stroke,especially disseminated intravascular coagulation( DIC),is one of the important causes of multiple organ failure and even death in patients. The pathogenesis of DIC related to heat stroke is still unclear,and its detection index and treatment lack of precision,which leads to a high mortality rate. In the future,clinical examination should be carried out early and accurately,timely correction of coagulation dysfunction,reconstruction of coagulation-anticoagulation system balance,reduction of systemic inflammatory response to prevent further deterioration of organ function should be done,so as to improve the prognosis of DIC in heat stroke patients.
引文
[1]Leon LR,Bouchama A.Heat stroke[J].Compr Physiol,2015,5(2):611-647.
[2]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.
[3]Leon LR,Helwig BG.Heat stroke:Role of the systemic inflammatory response[J].J Appl Physiol(1985),2010,109(6):1980-1988.
[4]Jilma B,Derhaschnig U.Disseminated intravascular coagulation in heat stroke:A hot topic[J].Crit Care Med,2012,40(4):1370-1372.
[5]Hifumi T,Kondo Y,Shimazaki J,et al.Prognostic significance of disseminated intravascular coagulation in patients with heat stroke in a nationwide registry[J].J Crit Care,2018,44(8):306-311.
[6]杨晓丽,邬明辉,焦晓静,等.热射病并弥漫性血管内凝血、多系统器官功能衰竭致死亡报告[J].临床误诊误治,2017,30(8):50-52.
[7]陈洁坤,宋青,周飞虎.凝血功能对重症劳力性热射病预后的影响及治疗策略[J].临床误诊误治,2014,27(4):52-56.
[8]Bruchim Y,Kelmer E,Cohen A,et al.Hemostatic abnormalities in dogs with naturally occurring heatstroke[J].J Vet Emerg Crit Care(San Antonio),2017,27(3):315-324.
[9]Bruchim Y,Segev G,Kelmer E,et al.Hospitalized dogs recovery from naturally occurring heatstroke;Does serum heat shock protein 72 can provide prognostic biomarker?[J].Cell Stress Chaperones,2016,21(1):123-130.
[10]Bouchama A,Al-Mohanna F,Assad L,et al.Tissue factor/factorⅦa pathway mediates coagulation activation in induced-heat stroke in the baboon[J].Crit Care Med,2012,40(4):1229-1236.
[11]Adams T,Stacey E,Stacey S,et al.Exertional heat stroke[J].Br J Hosp Med(Lond),2012,73(2):72-78.
[12]Roberts GT,Ghebeh H,Chishti MA,et al.Microvascular injury,thrombosis,inflammation,and apoptosis in the pathogenesis of heatstroke:A study in baboon model[J].Arterioscler Thromb Vasc Biol,2008,28(6):1130-1136.
[13]Vallet B,Wiel E.Endothelial cell dysfunction and coagulation[J].Crit Care Med,2001,29(7 Suppl):S36-41.
[14]Bouvy C,Gheldof D,Chatelain C,et al.Contributing role of extracellular vesicles on vascular endothelium haemostatic balance in cancer[J].J Extracell Vesicles,2014,11:3.
[15]Stacey MMJ,Delves SK,Woods DR,et al.Heart rate variability and plasma nephrines in the evaluation of heat acclimatisation status[J].Eur J Appl Physiol,2018,118(1):165-174.
[16]Racinais S,Alonso JM,Coutts AJ,et al.Consensus recommendations on training and competing in the heat[J].Sports Med,2015,45(7):925-938.
[17]Ganter MT,Hofer CK.Coagulation monitoring:Current techniques and clinical use of viscoelastic point-of-care coagulation devices[J].Anesth Analg,2008,106:1366-1375.
[18]Wan P,Yu M,Qian M,et al.Sonoclot coagulation analysis:Auseful tool to predict mortality in overt disseminated intravascular coagulation[J].Blood Coagul Fibrinolysis,2016,27(1):77-83.
[19]E Kehrel B,F Brodde M.State of the art in platelet function testing[J].Transf Med Hemother,2013,40(2):73-86.
[20]万鹏,童华生,张兴钦,等.Sonoclot分析仪在重症中暑并发弥漫性血管内凝血中的诊断价值[J].实用医学杂志,2014,30(16):2562-2565.
[21]苏磊,童华生.重症中暑转化医学研究回顾与展望[J].解放军医学杂志,2017,42(2):103-108.
[22]Kawasaki T,Okamoto K,Kawasaki C,et al.Thrombomodulin improved liver injury,coagulopathy,and mortality in an experimental heatstroke model in mice[J].Anesth Analg,2014,118(5):956-963.
[23]Tong H,Chen R,Yin H,et al.Mesenteric lymph duct ligation alleviating lung injury in heatstroke[J].Shock,2016,46(6):696-703.
[24]王全顺,周飞虎,潘亮,等.劳力性热射病并发弥散性血管内凝血的治疗[J].临床血液学杂志,2012,25(2):153-156.
[25]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.
[26]Chen F,Li H,Zhu G,et al.Sodium tanshinoneⅡA sulfonate improves inflammation,aortic endothelial cell apoptosis,disseminated intravascular coagulation and multiple organ damage in a rat heat stroke model[J].Mol Med Rep,2017,16(1):87-94.
[27]Lin XJ,Mei GP,Lin J,et al.Therapeutic effects of melatonin on heatstroke-induced multiple organ dysfunction syndrome in rats[J].J Pineal Res,2011,50(4):436-444.
[28]Ji J,Zhou F,Yue H,et al.Protective mechanism of Xuebijing injection against heat stroke in rats[J].Exp Ther Med,2014,7(6):1745-1751.
[29]Chen Y,Tong H,Pan Z,et al.Xuebijing injection attenuates pulmonary injury by reducing oxidative stress and proinflammatory damage in rats with heat stroke[J].Exp Ther Med,2017,13(6):3408-3416.
[30]卢纪杰,王春亭.乌司他丁治疗热射病的疗效[J].中国处方药,2016,14(5):70-71.
[31]季焱,翟金键,万朝琪.连续性血液净化联合乌司他丁治疗热射病的疗效分析[J].中国继续医学教育,2017,9(23):152-153.
[2]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.
[3]Leon LR,Helwig BG.Heat stroke:Role of the systemic inflammatory response[J].J Appl Physiol(1985),2010,109(6):1980-1988.
[4]Jilma B,Derhaschnig U.Disseminated intravascular coagulation in heat stroke:A hot topic[J].Crit Care Med,2012,40(4):1370-1372.
[5]Hifumi T,Kondo Y,Shimazaki J,et al.Prognostic significance of disseminated intravascular coagulation in patients with heat stroke in a nationwide registry[J].J Crit Care,2018,44(8):306-311.
[6]杨晓丽,邬明辉,焦晓静,等.热射病并弥漫性血管内凝血、多系统器官功能衰竭致死亡报告[J].临床误诊误治,2017,30(8):50-52.
[7]陈洁坤,宋青,周飞虎.凝血功能对重症劳力性热射病预后的影响及治疗策略[J].临床误诊误治,2014,27(4):52-56.
[8]Bruchim Y,Kelmer E,Cohen A,et al.Hemostatic abnormalities in dogs with naturally occurring heatstroke[J].J Vet Emerg Crit Care(San Antonio),2017,27(3):315-324.
[9]Bruchim Y,Segev G,Kelmer E,et al.Hospitalized dogs recovery from naturally occurring heatstroke;Does serum heat shock protein 72 can provide prognostic biomarker?[J].Cell Stress Chaperones,2016,21(1):123-130.
[10]Bouchama A,Al-Mohanna F,Assad L,et al.Tissue factor/factorⅦa pathway mediates coagulation activation in induced-heat stroke in the baboon[J].Crit Care Med,2012,40(4):1229-1236.
[11]Adams T,Stacey E,Stacey S,et al.Exertional heat stroke[J].Br J Hosp Med(Lond),2012,73(2):72-78.
[12]Roberts GT,Ghebeh H,Chishti MA,et al.Microvascular injury,thrombosis,inflammation,and apoptosis in the pathogenesis of heatstroke:A study in baboon model[J].Arterioscler Thromb Vasc Biol,2008,28(6):1130-1136.
[13]Vallet B,Wiel E.Endothelial cell dysfunction and coagulation[J].Crit Care Med,2001,29(7 Suppl):S36-41.
[14]Bouvy C,Gheldof D,Chatelain C,et al.Contributing role of extracellular vesicles on vascular endothelium haemostatic balance in cancer[J].J Extracell Vesicles,2014,11:3.
[15]Stacey MMJ,Delves SK,Woods DR,et al.Heart rate variability and plasma nephrines in the evaluation of heat acclimatisation status[J].Eur J Appl Physiol,2018,118(1):165-174.
[16]Racinais S,Alonso JM,Coutts AJ,et al.Consensus recommendations on training and competing in the heat[J].Sports Med,2015,45(7):925-938.
[17]Ganter MT,Hofer CK.Coagulation monitoring:Current techniques and clinical use of viscoelastic point-of-care coagulation devices[J].Anesth Analg,2008,106:1366-1375.
[18]Wan P,Yu M,Qian M,et al.Sonoclot coagulation analysis:Auseful tool to predict mortality in overt disseminated intravascular coagulation[J].Blood Coagul Fibrinolysis,2016,27(1):77-83.
[19]E Kehrel B,F Brodde M.State of the art in platelet function testing[J].Transf Med Hemother,2013,40(2):73-86.
[20]万鹏,童华生,张兴钦,等.Sonoclot分析仪在重症中暑并发弥漫性血管内凝血中的诊断价值[J].实用医学杂志,2014,30(16):2562-2565.
[21]苏磊,童华生.重症中暑转化医学研究回顾与展望[J].解放军医学杂志,2017,42(2):103-108.
[22]Kawasaki T,Okamoto K,Kawasaki C,et al.Thrombomodulin improved liver injury,coagulopathy,and mortality in an experimental heatstroke model in mice[J].Anesth Analg,2014,118(5):956-963.
[23]Tong H,Chen R,Yin H,et al.Mesenteric lymph duct ligation alleviating lung injury in heatstroke[J].Shock,2016,46(6):696-703.
[24]王全顺,周飞虎,潘亮,等.劳力性热射病并发弥散性血管内凝血的治疗[J].临床血液学杂志,2012,25(2):153-156.
[25]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.
[26]Chen F,Li H,Zhu G,et al.Sodium tanshinoneⅡA sulfonate improves inflammation,aortic endothelial cell apoptosis,disseminated intravascular coagulation and multiple organ damage in a rat heat stroke model[J].Mol Med Rep,2017,16(1):87-94.
[27]Lin XJ,Mei GP,Lin J,et al.Therapeutic effects of melatonin on heatstroke-induced multiple organ dysfunction syndrome in rats[J].J Pineal Res,2011,50(4):436-444.
[28]Ji J,Zhou F,Yue H,et al.Protective mechanism of Xuebijing injection against heat stroke in rats[J].Exp Ther Med,2014,7(6):1745-1751.
[29]Chen Y,Tong H,Pan Z,et al.Xuebijing injection attenuates pulmonary injury by reducing oxidative stress and proinflammatory damage in rats with heat stroke[J].Exp Ther Med,2017,13(6):3408-3416.
[30]卢纪杰,王春亭.乌司他丁治疗热射病的疗效[J].中国处方药,2016,14(5):70-71.
[31]季焱,翟金键,万朝琪.连续性血液净化联合乌司他丁治疗热射病的疗效分析[J].中国继续医学教育,2017,9(23):152-153.