军事训练致劳力型热射病易感因素与临床表现分析

Retrospective analysis of predisposing factors and clinical manifestations in military training induced exertional heat stroke patients

目的:分析因军事训练致劳力性热射病(EHS)的发病原因及临床表现。方法:回顾性分析2012年1月—2016年6月共14例EHS患者的临床资料,考察其发病影响因素和临床表现。结果结果:补水不够、睡眠不足和存在诱发疾病是EHS发病的最常见易感因素;患者在病程中出现意识障碍、弥散性血管内凝血、多脏器功能障碍综合征和横纹肌溶解等症状。入院时均存在电解质紊乱,血清钾(K^+)均高出正常范围,钠(Na^+)、氯(Cl^-)则均偏低;丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)异常升高,AST尤其明显,胆红素升高幅度不大;尿素氮(BUN)和肌酐(Cr)升高幅度较大,尿酸(UA)的异常表现相对不明显;肌酸肌酶(CK)、乳酸脱氢酶(LDH)入院时异常病例数较少,两天后明显增加,发生横纹肌溶解的患者CK升高幅度可达十余倍,并伴肌红蛋白尿,肌酸激酶同工酶MB(CKMB)异常表现相对不明显,肌红蛋白(Mb)始终处于高位,且均有十倍以上升高。活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)和凝血酶时间(TT)均延长,纤维蛋白原(FIB)降低;白细胞(WBC)、红细胞(RBC)升高。结论:军事训练中应针对发病因素加强EHS的预防,在EHS治疗中应密切关注患者的特征性表现。

Objective:To investigate the pathogenesis and clinical manifestations of exertional heat stroke(EHS) induced by military training. Methods:The clinical data of 14 patients with EHS admitted from January 2012 to June 2016 were retrospectively analyzed. Results:Insufficient water supply, lack of sleep and practicing with induced disease were the most common predisposing factors of EHS; In the course of EHS, the patients appeared symptoms such as consciousness disorder, disseminated intravascular coagulation, multiple organ dysfunction syndrome and rhabdomyolysis et al. At the time of admission, there was electrolyte disturbance, serum potassium(K^+) was higher than the normal limit, sodium(Na^+) and chlorine(Cl^-) were low. Alanine aminotransferase(ALT) and aspartate aminotransferase(AST) were significantly increased, especially in AST, and the increase of bilirubin was not significant. The level of urea nitrogen(BUN) and creatinine(Cr) increased significantly, and uric acid(UA) was abnormal. Creatine kinase(CK) and lactate dehydrogenase(LDH) in patients with abnormal number of cases were significantly increased after two days. Rhabdomyolysis in patients with CK increased up to more than ten times, and with myoglobinuria, creatine kinase, MB isoenzyme(CKMB) abnormal performance is not obvious, myoglobin(Mb) always at a high level, and has more than ten times. Activated partial thromboplastin time(APTT), prothrombin time(PT) and thrombin time(TT) were extended, fibrinogen(FIB) decreased;white blood cell(WBC) and red blood cell(RBC) rised. Conclusion:In military training, the prevention of EHS should be strengthened according to the pathogenic factors. The clinical characteristics of patients should be paid close attention in EHS treatment.