Clinical analysis of 18 patients with multiple organ dysfunction syndrome caused by severe heat stroke
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摘要:目的 分析重症中暑致多器官功能障碍综合征(MODS)患者的临床特点。方法 回顾性分析18例重症中暑致MODS患者临床资料以及实施集束化治疗的措施, 观察临床疗效。结果 所有患者均表现为高热，平均体温(40.50±1.80) ℃, 白细胞计数(WBC)、C反应蛋白(CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)等炎症指标明显升高，异常率65%以上, 15例符合全身炎症反应综合征(SIRS); 凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)明显延长, D-二聚体明显升高，异常率80%以上; 共累及受损器官70个，循环系统、肾脏、凝血系统居前3位。给予集束化治疗后，患者脏器功能障碍多能及时逆转，恢复较快。结论 热损伤、SIRS和凝血功能异常等多个机制参与了重症中暑的病理生理过程，集束化治疗疗效显著。
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关键词:
- 重症中暑 /
- 多器官功能障碍综合征 /
- 全身炎症反应综合征 /
- 集束化治疗 /
- 发病机制
Abstract:Objective To analyze the clinical features of patients with multiple organ dysfunction syndrome (MODS) caused by severe heat stroke.Methods Clinical data and measures for cluster therapy of 18 patients with MODS caused by severe heat stroke were retrospectively analyzed, and clinical efficacy was observed.Results All the patients were characterized by high fever, the average temperature was (40.5±1.8) ℃, and inflammatory indicators such as white blood cell count (WBC), C reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) significantly increased with an abnormal rate over 65%. Fifteen patients met the criteria of systemic inflammatory response syndrome (SIRS), prothrombin time (PT) and activated partial thromboplastin time (APTT) significantly prolonged, D-Dimer level significantly increased, and the abnormal rate was more than 80%. A total of 70 injured organs were involved, and the circulatory system, kidney and coagulation system ranked the top three. After implementation of cluster therapy, the patients′organ dysfunction can be reversed in time and recovered quickly.Conclusion Several mechanisms, such as heat injury, SIRS and coagulation dysfunction, are involved in the pathophysiological process of severe heat stroke. Cluster therapy is effective. -
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表 1 18例重症中暑致MODS患者入院即刻实验室检查指标(x±s)[n(%)]
指标 监测数据 异常 参考值 WBC/(×109/L) 16.23±7.28 14(77.80) 4~10 PLT/(×109/L) 138.41±84.56 10(55.60) 100~300 CRP/(mg/L) 96.54±63.48 16(88.90) <10 IL-6/(mg/L) 24.60±9.30 12(66.70) 0~5.9 TNF-α/(mg/L) 35.20±17.60 16(88.90) 0~8.1 PT/s 11.12±2.23 15(83.30) 9.8~12.7 APTT/s 30.50±5.85 15(83.30) 25.5~34.7 FIB/(g/L) 2.15±0.97 8(44.40) 2.00~4.00 D-二聚体/(mg/L) 7.58(1.62, 13.59) 17(94.40) <0.55 WBC: 白细胞计数; PLT: 血小板计数; CRP: C反应蛋白; IL-6: 白介素-6; TNF-α: 肿瘤坏死因子-α; PT: 凝血酶原时间; APTT: 活化部分凝血活酶时间; FIB: 纤维蛋白原。 
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[1] Mohanaselvan A, Bhaskar E. Mortality from non-exertional heat stroke still high in India[J]. Int J Occup Environ Med, 2014, 5(4): 222-224. http://www.ncbi.nlm.nih.gov/pubmed/25270013
[2] Chen K, Huang L, Zhou L, et al. Spatial analysis of the effect of the 2010 heat wave on stroke mortality in Nanjing, China[J]. Sci Rep, 2015, 5: 10816-10824. doi: 10.1038/srep10816
[3] 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. https://www.cnki.com.cn/Article/CJFDTOTAL-JFJY201501001.htm [4] 邱海波, 杜斌, 刘大为, 等. 全身炎症反应综合征与多器官功能障碍综合征的临床研究[J]. 中华外科杂志, 1997, 35(7): 402-405. doi: 10.3760/j:issn:0529-5815.1997.07.008 [5] 杨巧云, 刘文明, 俞建峰, 等. 重症中暑患者的临床特点及集束化治疗[J]. 中国急救医学, 2011, 31(8): 736-739. doi: 10.3969/j.issn.1002-1949.2011.08.017 [6] 中华医学会重症医学分会. 成人严重感染与感染性休克血流动力学监测及支持指南(草案)[J]. 中华危重病急救医学, 2007, 19(3): 129-133. doi: 10.3760/j.issn:1003-0603.2007.03.001 [7] 陈怿, 童华生, 张兴钦, 等. 乌司他丁减轻重症中暑大鼠肺的炎症和氧化损伤[J]. 中华急诊医学杂志, 2014, 23(8): 866-870. doi: 10.3760/cma.j.issn.1671-0282.2014.08.009 [8] 倪啸晓, 刘志锋, 谢秋幼, 等. 中暑脑损伤机制及高压氧治疗作用的研究进展[J]. 中华危重病急救医学, 2017, 29(6): 572-576. doi: 10.3760/cma.j.issn.2095-4352.2017.06.020 [9] 中国医师协会内分泌代谢科医师分会, 中国住院患者血糖管理专家组. 中国住院患者血糖管理专家共识[J]. 中华内分泌代谢杂志, 2017, 33(1): 1-10. doi: 10.3760/cma.j.issn.1000-6699.2017.01.001 [10] Glaser J, Lemery J, Rajagopalan B, et al. Climate change and the emergent epidemic of CKD from heat stress in rural communities: the case for heat stress nephropathy[J]. Clin J Am Soc Nephrol, 2016, 11(8): 1472-1483. doi: 10.2215/CJN.13841215
[11] 汪正权, 屠旭旦, 陆雯, 等. 热射病患者临床预后的预测指标分析[J]. 中华急诊医学杂志, 2016, 25(8): 1058-1061. doi: 10.3760/cma.j.issn.1671-0282.2016.08.019 [12] 盛孝燕. 13例重症中暑患者救治分析[J]. 中国急救复苏与灾害医学杂志, 2010, 5(7): 670-671. doi: 10.3969/j.issn.1673-6966.2010.07.040 [13] Yokobori S, Koido Y, Shishido H, et al. Feasibility and safety of intravascular temperature management for severe heat stroke: A prospective multicenter pilot study[J]. Crit Care Med, 2018, 46(7): e670-e676. doi: 10.1097/CCM.0000000000003153
[14] 孙邦旭, 杨娟. 重症中暑患者的院外急救策略探讨[J]. 中国急救复苏与灾害医学杂志, 2015, 10(3): 262-263. doi: 10.3969/j.issn.1673-6966.2015.03.022 [15] 潘志国, 邵玉, 刘亚楠, 等. 重症中暑患者入院早期凝血功能指标与预后的关系[J]. 中华危重病急救医学, 2013, 25(12): 725-728. doi: 10.3760/cma.j.issn.2095-4352.2013.12.007 [16] 曹才文, 何旋, 李莉, 等. 重症中暑早期肠黏膜屏障功能损害与全身炎症反应的相关性研究[J]. 中华危重病急救医学, 2016, 28(4): 303-307. doi: 10.3760/cma.j.issn.2095-4352.2016.04.003 [17] 周高速, 陈冬梅, 王贵生, 等. 热射病并发多器官功能障碍综合征三例临床救治分析[J]. 中国急救复苏与灾害医学杂志, 2009, 4(9): 721-723. doi: 10.3969/j.issn.1673-6966.2009.09.029 [18] 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. doi: 10.3760/cma.j.issn.2095-4352.2015.08.006 [19] 熊全. 劳力性热射病的研究进展[J]. 中国急救复苏与灾害医学杂志, 2014, 9(6): 560-562. doi: 10.3969/j.issn.1673-6966.2014.06.024 [20] 周军, 冯宪真, 张俊杰, 等. 重症中暑多器官功能衰竭伴二次昏迷治疗成功1例病例报道[J]. 实用临床医药杂志, 2015, 19(15): 199-199. https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL201515070.htm [21] 卓兴利. 重症中暑并发多脏器功能障碍综合征发病机制研究进展[J]. 临床医药文献电子杂志, 2017, 4(67): 13248-13249. doi: 10.3877/j.issn.2095-8242.2017.67.101 [22] 周刊, 陆恩峰, 肖琦, 等. 血浆置换联合连续性血液净化在热射病导致多器官功能障碍综合征的救治分析[J]. 中国中西医结合肾病杂志, 2015, 16(8): 721-723. https://www.cnki.com.cn/Article/CJFDTOTAL-JXSB201508024.htm [23] 李代波, 周欢, 刘乐斌. 热射病的发病机制及防治研究进展[J]. 解放军预防医学杂志, 2017, 35(12): 1598-1601. https://www.cnki.com.cn/Article/CJFDTOTAL-JYYX201712035.htm [24] 易高. ROS介导的溶酶体—线粒体途径在热打击诱导肠道损伤中的作用[D]. 广州: 南方医科大学, 2017.
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