亚低温在劳力型热射病治疗中的应用  

Application of mild hypothermia in the treatment of exertion heat stroke

作　　者：刘辉[1] 宋青[1] 周飞虎[1] 潘亮[1] 康红军[1] 谢菲[1] 岳慧[1] 

机构地区：[1]解放军总医院外科重症医学科,北京100853

出　　处：《解放军医学杂志》2010年第9期1148-1150,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨快速亚低温处理在劳力型热射病(EHS)救治中的作用。方法回顾性总结2001年9月-2009年8月间7所部队医院收治的28例EHS患者的临床资料,将发病后4h内将肛温降低到亚低温(35.0±0.5℃)的患者归入亚低温组(n=16),将肛温大于40℃超过3h的患者归入延迟降温组(n=12),比较两组患者入院后0、12、24、48、72h的肌酸激酶(CK)和乳酸脱氢酶(LDH)水平,并比较两组的病死率和升压药使用时间,分析亚低温在热射病治疗中的作用。结果入院24h后延迟降温组CK值显著高于亚低温组(P<0.05或P<0.01),亚低温组LDH值在24～48h后开始下降,48、72h时显著低于延迟降温组(P<0.01)。亚低温组与延迟降温组的病死率分别为0%和25.0%(P<0.05)。亚低温组使用升压药的时间(68.5±39.7h)明显短于延迟降温组(228.7±139.7h,P<0.01)。结论迅速应用亚低温处理能有效减轻脏器损伤程度,改善热射病患者全身情况及预后,是治疗EHS的重要措施。Objective To investigate the therapeutic effect of rapid mild hypothermia in the treatment of exertion heat stroke （EHS）.Methods Clinical data of 28patients with EHS collected from 7military hospitals from Sep.2001to Aug.2009were retrospectively analyzed.Patients were assigned into 2groups according to receiving or not receiving treatment of mild hypothermia in time. Patients with rectal temperature decreased to 35.0±0.5℃in 4hours were assigned to the mild hypothermia group（n=16）,while those with rectal temperature over 40℃for longer than 3hours were assigned to the delayed hypothermia treatment group（n=12）.The values of creatine kinase（Cr）and lactate dehydrogenase（LDH）were compared between the two groups at 0,12,24,48and 72hours after hospitalization.The mortality and time of administration of pressor agents were also compared.The therapeutic effect of rapid mild hypothermia treatment in EHS was analyzed.Results The value of serum Cr was lower in patients of mild hypothermia group than in patients of delayed hypothermia group 24hours after hospitalization.The LDH level of mild hypothermia group decreased at 24―48hand markedly lower than that of delayed hypothermia group at 48hand 72h（P0.01）.The mortality rate of mild hypothermia and delayed hypothermia group was 0and 25.0% （3/12,P0.05）,respectively.The time of administration of pressor agents for patients in mild hypothermia group was about 68.5±39.7hours,which was markedly shorter than that for patients of delayed hypothermia group,which was about 228.7±139.7hours.Conclusions Rapid mild hypothermia treatment results in alleviation of organ injury,improvement of vital signs and a decrease in mortality,thus it shows valuable therapeutic effect in the treatment of EHS.

关 键 词：热射病 低温 人工 多器官功能衰竭 

分 类 号：R594.12[医药卫生—内科学]