置换液冷处理在热射病患者连续性血液净化治疗中的应用  

Application of cold treatment of replacement fluid in continuous blood purification of patients with heat stroke

作　　者：谢丹婷 何园园 谭学增 宋青[1] 刘杰[1] 胡江滨[1] 范凤云[1] 邱祥威 Xie Danting;He Yuanyuan;Tan Xuezeng;Song Qing;Liu Jie;Hu Jiangbin;Fan Fengyun;Qiu Xiangwei(Department of Critical Medicine,Hainan Hospital of PLA General Hospital,Sanya 572013,China)

机构地区：[1]解放军总医院海南医院重症医学科,海南三亚572013 [2]暨南大学护理学院

出　　处：《海军医学杂志》2025年第4期378-382,共5页Journal of Navy Medicine

基　　金：海南省自然基金面上项目(823MS165);海南省临床医学中心建设项目(202233)。

摘　　要：目的探究置换液冷处理在热射病患者连续性血液净化(CBP)治疗中的临床效果。方法选取2018年7月至2022年9月解放军总医院海南医院收治的46例行CBP治疗的热射病患者的临床资料进行回顾性分析,将给予常规热射病治疗及常温置换液CBP的23例患者作为对照组,给予常规热射病治疗及置换液冷处理CBP的23例患者作为观察组,比较2组患者治疗前及治疗后30 min、2 h、6 h、12 h、24 h的体温,同时对比2组患者治疗前及治疗后24 h(T1)、3 d(T2)、7 d(T3)的凝血酶原活动度(PTA)、活化部分凝血活酶时间(APTT)、D⁃二聚体(D⁃D)、纤维蛋白原(FIB)、血小板计数(PLT)变化及7 d的急性生理学及慢性健康状况(APACHEⅡ)评分。结果2组患者治疗前体温和凝血功能各项指标比较差异无统计学意义(P>0.05)。治疗后2 h、6 h、12 h,观察组体温与对照组比较差异有统计学意义(P<0.05)。治疗后,T1、T2、T3时间点观察组PTA、FIB、PLT水平均高于对照组,D⁃D水平低于对照组,APTT在T1、T2时间点短于对照组,差异有统计学意义(P<0.05)。2组患者治疗后PTA、APTT、D⁃D、FIB、PLT均较治疗前好转(P<0.05)。结论置换液冷处理后用于热射病患者CBP具有重要的应用价值,其可快速缩短热射病患者的降温时间,改善患者凝血功能,值得临床推广,以更好地改善热射病患者的预后。Objective To explore the clinical effect of cold treatment of replacement fluid in continuous blood purification(CBP)of patients with heat stroke.Methods Clinical data of 46 patients with heat stroke who were treated with CBP in Hainan Hospital of PLA General Hospital from July 2018 to September 2022 were retrospectively analyzed.The patients were assigned to control group(23 cases,conventional treatment for heat stroke and CBP with room temperature replacement fluid)and observation group(23 cases,conventional treatment for heat stroke and CBP with cooling replacement fluid).The body temperatures were compared between the two groups before treatment and 30 min,2 h,6 h,12 h and 24 h after treatment.The prothrombin activity(PTA),activated partial thromboplastin time(APTT),D⁃dimer(D⁃D),fibrinogen(FIB)and platelet count(PLT)before treatment and at 24 h(T1),3 d(T2)and 7 d(T3)after treatment,as well as the Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score at 7 d after treatment were also compared between the two groups.Results There was no significant difference in temperature or coagulation function between the two groups before treatment(P>0.05).The temperature of the observation group was significantly different from that of the control group at 2 h,6h and 12h after treatment(P<0.05).After treatment,the levels of PTA,FIB and PLT in the observation group at T1,T2 and T3 were higher than those in the control group,while the level of D⁃D in the observation group was lower than that in the control group,and the APPT at T1 and T2 was significantly shorter than that in the control group(P<0.05).PTA,APPT,D⁃D,FIB and PLT of the two groups were improved after treatment(P<0.05).Conclusion The cold treatment of replacement fluid can quickly shorten the cooling time of patients with heat stroke during CBP,and significantly improve coagulation function.It is worthy of clinical promotion so as to improve the progrosis of patients with heat strok.

关 键 词：热射病 连续性血液净化 置换液冷处理 凝血功能 体温 

分 类 号：R594.11[医药卫生—内科学]