热射病并发横纹肌溶解症伴弥漫性血管内凝血的临床分析

Clinical analysis of heat stroke complicated with rhabdomyolysis and disseminated intravascular coagulation

目的对我院近6年来收治的并发横纹肌溶解症伴弥漫性血管内凝血的重症热射病的临床资料进行总结。方法我院在2006年1月～2012年7月共收治热射病患者15例,并发横纹肌溶解伴弥漫性血管内凝血的7例热射病患者作为观察组,其余患者作为对照组,每日检测血气分析、肌酶谱、凝血功能。结果所有患者均在起病0.5～10 h内住院,表现为高热、意识障碍。观察组血小板明显低于对照组,CK、AST、肌酐、PT、APTT明显升高,差异有统计学意义。对照组所有患者经过治疗后神志转清好转出院,观察组7例患者死亡5例,2例存活,出院时为睁眼昏迷,植物状态。结论并发有横纹肌溶解症伴弥漫性血管内凝血的重症热射病,病情进展迅速,死亡率高,存活患者遗留有明显神经系统后遗症状,需尽早控制体温,大量补液,尽早进行血液净化,低分子肝素及丹参的应用有良好的抗凝和改善微循环作用,对于纠正DIC起到关键作用。

Objective To Summarize the clinical findings and treatmeng of the patients with heat stroke complicated with rhabdomyolysis and disseminated intravascular coagulation over the past 6 years. Methods Complicated with rhabdomyolysis and disseminated intravascular coagulation in heatstroke patients as the observation group, the remain- ing patients as control group. The measurement included blood gas analysis, creatine kinase, coagulatory function. Re- suits All patients presented with high fever, consciousness disturbance, shock.The observation group was significantly lower than the control group in platelets, CK, AST, PT, APT？, creatinine increased obviously; the difference was sta- tistically significant.The control group all patients after treatment of Consciousness recovery had recovered.The obser- vation group 7 cases and 5 patients died of multiple organ failure （MOF）, while the other 2 paitent.s were survival with coma vigil. Conclusion Patients with rapid progress, a high mortality, Survival in patients with left has obvious neuro- logical sequela. Early blood purification, low molecular weight heparin and Salvia miltiorrhiza for correcting the DIC played a key role.