成功救治劳力性热射病合并急性颅脑损伤1例

Successful treatment of exertional heat stroke accompanying acute brain injury: A case report

目的报告1例合并急性颅脑损伤的劳力性热射病的临床诊治过程。方法报道并分析我科1例劳力性热射病合并急性颅脑损伤的患者的临床表现、影像学诊断、临床治疗及疗效,结合文献进行回顾性分析。结果患者男性,18岁,因剧烈运动后发热伴意识丧失36 h于2012年8月4日入院。根据病史及入院时化验检查结果可明确诊断为劳力性热射病,结合入院后临床表现及影像学检查可诊断为急性颅脑损伤;经积极降温、持续床旁血液净化、高压氧及对症支持治疗后各化验指标基本恢复正常,意识恢复,基本交流尚可,肌力功能处于恢复过程。结论劳力性热射病合并急性颅脑损伤结合临床表现及早期影像学检查等有助于早期诊治。

Objective To report the diagnosis and treatment of a patient with exertional heat stroke accompanying acute brain injury. Methods Clinical data （including clinical manifestations, imaging diagnosis, clinical treatment and its efficiency） about a patient with exertional heat stroke accompanying acute brain injury were retrospectively analyzed with its related literature reviewed. Results The patient was a 18 years old male soldier. He was admitted to our hospital due to fever accompanying loss of consciousness after strenuous exercise and diagnosed as exertional heat stroke according to his medical history and laboratory testing. He was finally diagnosed as acute brain injury according to his clinical manifestations and imaging findings after admission. His laboratory test became almost normal and his consciousness was recovered, basic communication was possible with him, and his myodynamia was improved after active cooling, continuous bedside blood purification, hyperbaric oxygen therapy （HBOT） and expectant supportive treatment. Conclusion Clinical manifestations and early imaging findings of exertional heat stroke accompanying acute brain injury contribute to its diagnosis and treatment.