军事训练导致劳力性热射病早期救治策略

Early treatment strategies of labor heat shock disease caused by military training

目的探讨军事训练导致的劳力性热射病早期救治方法。方法方法:回顾分析2015年4月—2018年9月本院收治的35例劳力性热射病的早期救治措施。比较进行集束化治疗后患者体温、器官功能指标及凝血指标的变化。结果除血钾浓度外,与入院时相比,给予集束化治疗后患者出院时的临床指标明显好转:体温降至正常,ALT中位数由入院时的301U/L降至34U/L(p<0.05),Cr中位数由入院时的轻度升高(129μmmol/L)降至正常范围(66μmmol/L)(p<0.001),CK-MB也明显下降(68 vs 18)(p<0.05)。同时,凝血功能得到不同程度改善:PT下降(17.8 vs 13.0)(p<0.05),D-dimer下降(3.48 vs 0.76)(p<0.05),PLT明显上升(115.0×109/L vs 244×109/L)(p<0.05)。收治的35例患者中,33例治愈出院,2例死亡。结论军事训练导致的劳力性热射病患者应给予早期快速降温、早期快速补液、早期快速器官功能支持等集束化治疗,以改善临床症状。此外,早期持续小剂量的抗凝治疗,能够降低弥散性血管内凝血(DIC)的发生率。

Objective To investigate the early treatment of exertion heat stroke(EHS) induced by military training.Methods;The early treatment measures of 35 cases of labor heat stroke admitted to our hospital from April 2015 to September 2018 were retrospectively analyzed.The changes of body temperature,organ function index and coagulation index after cluster therapy were compared.Results:In addition to serum potassium concentration,the clinical indicators of patients discharged from hospital after cluster therapy were significantly improved:body temperature dropped to normal,median ALT decreased from 301 U/L to 34 U/L(P<0.05),median Cr increased slightly(129 ummol/L) at admission to normal range(66 ummol/L)(P<0.001),and CK-MB decreased significantly(68 vs 18)(P<0.05).At the same time,coagulation function was improved in different degrees:PT decreased(17.8 vs 13.0)(P<0.05),D-dimer decreased(3.48 vs 0.76)(P<0.05),PLT increased significantly(115.0 *109/L vs 244 *109/L)(P<0.05).Of the 35 patients admitted,33 cases were cured and discharged,and 2 cases were died.Conclusion:Patients with exertional heat stroke caused by military training should be given early rapid cooling,early rapid fluid replacement and early rapid organ function support to improve clinical symptoms.In addition,early continuous low dose anticoagulation therapy can reduce the incidence of disseminated intravascular coagulation(DIC).