军事训练致重症劳力性热射病血液保障分析——附2例报告  

Analysis of blood transfusion support for severe exertional heat stroke during military training: two case reports

作　　者：史恩祥[1] 王伟[1] 温艳平[1] 丁秀丽[1] 贺丽娜[1] 赵燕[1] 

机构地区：[1]解放军第251医院输血科,河北张家口075000

出　　处：《中国输血杂志》2016年第10期1159-1161,共3页Chinese Journal of Blood Transfusion

摘　　要：目的探讨劳力性热射病患者重建凝血-抗凝系统平衡的血液保障特点,为能够获得及时足量有效的血液成分治疗提供参考。方法收治2个病例均为既往体健男性,在同一时间段、同样环境条件、同等训练强度下患劳力性热射病。根据病情程度选择血液成分种类、治疗方式、用量大小、用血时限。结果患者发病后TEG提示血液明显低凝状态,血小板、凝血因子、纤维蛋白原功能不足,并呈进行性变化,需补充血小板、血浆、冷沉淀,病例1在此基础上进行了血浆置换治疗。病例1在<8 d内输注单采血小板26 U、新鲜冰冻血浆31 710m L、冷沉淀110 U,经治疗48 d康复出院。病例2在3 d内输注单采血小板2 U、新鲜冰冻血浆3 800 m L,冷沉淀20 U。经治疗8 d康复出院。结论患者因病情程度不同,血液的使用差别较大,血液成分种类选择、用量大小、治疗方式、用血时限与病情严重程度密切相关。本文认为劳力性热射病的血液保障工作要做到"六早",及早介入到院前急救前接后送阶段,做到病情程度早了解,患者血型早知道,库存血液早准备,应急预案早实施,及早实施早期目标导向凝血治疗,确保血液成分供的上、救得及、效果好。Objective To investigate the characteristics of reconstruction of the blood coagulation and anticoagulation balance in patients with exertional heat stroke, and to provide reference for timely and effective blood component transfusion treatment. Methods Two cases were collected. They were previously healthy, but suffered from exertional heat stroke under same period of time, same environmental conditions and equivalent training intensity. Appropriate choice of blood compo- nents for transfusion, treatment method, dosage and time were determined according to the degree of illness. Results TEG analysis indicated that the patients were in significantly lower coagulable state. The function of platelets, clotting factors and fibrinogen were all insufficient, and were in dynamic state. It was necessary to supplement these patients with platelets, plas- ma and cryoprecipitate. Case 1 was treated with plasmapheresis on this basis. Case 1 received transfusion treatment with 26 units of apheresis platelets, 31 710 mL fresh frozen plasma and 110 units cryoprecipitate. Within eight days, case 1 recovered and left hospital after 48 days of treatment. Case 2 received transfusion treatment with 2 units of apheresis platelets, 3 800 mL fresh frozen plasma and 20 units of cryoprecipitate. Within three days, case 2 recovered and left hospital after eight days of treatment. Conclusion The use of blood transfusion treatment was different due to different degrees of illness. The choice of the type of blood components for transfusion, the treatment method, dosage and time were closely associated with the severity of the disease. This paper considers that blood transfusion support for severe exertional heat stroke should meet ＇ six early＇ criteria, including early to enter the pre-hospital first aid before accepting evacuation stage, early to know the severity, early to know the blood type, early to prepare the stored blood, early to implement the emergency plan, and early to implement the early goal-directed coagulation therapy. T

关 键 词：劳力性热射病 军事训练 血液保障 

分 类 号：R594.12[医药卫生—内科学] R825.93[医药卫生—临床医学]