重症中暑致多器官功能障碍综合征18 例临床分析

Clinical Analysis of 18 Cases of Severe Heat Stroke with Multiple Organ Dysfunction Syndrome

目的 分析重症中暑致多器官功能障碍综合征(MODS)患者的临床特点,探讨其发病机制,为集束化治疗提供依据.方法 回顾性分析18 例重症中暑致MODS患者临床资料,实施集束化治疗措施,观察临床疗效.结果 18 例患者均表现为高热,平均体温(40.5±1.8)℃;WBC、CRP、IL-6、TNF-α等炎症指标明显升高,异常率65%以上,15 例符合全身炎症综合征(SIRS);共累及受损器官70 个,循环系统、肾脏、凝血系统居前3位.经集束化治疗后患者脏器功能障碍多能及时逆转,恢复较快.结论 热损伤、SIRS和内毒素血症等多个机制参与了重症中暑,集束化治疗疗效显著,值得借鉴推广.

Objective To analyze the clinical features and clarify the pathogenesis of patients with multiple organ dysfunction syndrome (MODS) caused by severe heat stroke, so as to provide a basis for cluster therapy. Methods Retrospective analysisonclinical data of 18 patients with MODS caused by severe heat stroke was done. The patients were treated with cluster therapy and the clinical efficacy was observed. Results All the patients were characterized by high fever, and the average temperature (0.5±1.8) ℃. Inflammatory indices, such as WBC, CRP, IL-6 and TNF-α, were significantly increased, with an abnormal rate of over 65%. 15 patients met the criteria of systemic inflammatory response syndrome (SIRS). A total of 70 damaged organs were involved, and the circulatory system, kidney and coagulation system ranked the top 3. The dysfunction of the organs can be reversed in time and recovered quickly after cluster therapy. Conclusion Multiple mechanisms, including thermal injury, SIRS, and endotoxemia, are involved in severe heat stroke. The effect of cluster therapy is good and worth popularizing.