重症中暑临床救治方法现状与研究进展

Current status and research progress of clinical management for severe heat stroke

中暑是一种严重威胁健康的危重疾病,病情进展迅速,可出现全身炎症反应综合征(SIRS)和多脏器功能障碍综合征(MODS)而导致高病死率,即使存活者也有近30%存在神经等系统后遗症。传统上重症中暑的治疗以积极降温为核心,被称为中暑救治“第一关键点”。但近来研究发现,除了降温,积极治疗早期脏器损害,防止单一脏器损害向MODS发展,是改善重症中暑预后的关键,并由此提出“第二关键点假说”。基于以上认识,近十年来逐渐发展出了一系列新的治疗手段,但目前重症中暑整体临床治疗仍缺乏规范、统一的方案,其中某些治疗的疗效也尚未明确。本文主要从降温及全身脏器支持保护的角度,围绕“第一和第二关键点”救治理论,总结近年来临床上重症中暑救治措施的现状与研究进展,为规范临床救治和深入研究提供参考。

Heat stroke is a critical and health-threatening disease,which progresses rapidly and leads systemic inflammatory response syndrome(SIRS)and multiple organ dysfunction syndrome(MODS),results in a high mortality rate.Nearly 30%of survivors will get neurological sequelae.Active cooling,which called the″first key point″,is crucial in the traditionally heatstroke treatment.However,recent studies have found that in addition to cooling,active strategies for organ damage prevent single organ damage from developing to MODS is critical for better outcome in patients with heat stroke.Based on these,″second key point hypothesis″is put forward and a series of new treatment strategies have been developed gradually during the past decade.However,there is still a lack of standardized and unified clinical protocol for severe heat stroke,and the efficacy of some treatments is not yet clear.In this review,we talk about the cooling and systemic organ support which focusing on″the first and the second key points″,conclude the current situation and research progress of the treatment strategies for severe heat stroke in clinical practice in recent years,so as to provide reference for standard management and further study.