Background: Heat stroke(HS) is a serious, life-threatening disease. However, there is no scoring system for HS so far. This research is to establish a scoring system that can quantitatively assess the severity of exer...Background: Heat stroke(HS) is a serious, life-threatening disease. However, there is no scoring system for HS so far. This research is to establish a scoring system that can quantitatively assess the severity of exertional heat stroke(EHS).Methods: Data were collected from a total of 170 exertional heat stroke(EHS) patients between 2005 and 2016 from 52 hospitals in China. Univariate statistical methods and comparison of the area under the receiver operating characteristic(ROC) curve(AUC) were used to screen exertional heat stroke score(EHSS) parameters, including but not limited body temperature(T), Glasgow Coma Scale(GCS) and others. By comparing the sizes of the AUCs of the APACHE II, SOFA and EHSS assessments, the effectiveness of EHSS in evaluating the prognosis of EHS patients was verified.Results: Through screening with a series of methods, as described above, the present study determined 12 parameters – body temperature(T), GCS, p H, lactate(Lac), platelet count(PLT), prothrombin time(PT), fibrinogen(Fib), troponin I(Tn I), aspartate aminotransferase(AST), total bilirubin(TBIL), creatinine(Cr) and acute gastrointestinal injury(AGI) classification – as EHSS parameters. It is a 0–47 point system designed to reflect increasing severity of heat stroke. Low(EHSS<20) and high scores(EHSS>35) showed 100% survival and 100% mortality, respectively. We found that AUCEHSS>AUCSOFA>AUCAPACHE II.Conclusions: A total of 12 parameters – T, GCS, p H, Lac, PLT, PT, Fib, Tn I, AST, TBIL, Cr and gastrointestinal AGI classification – are the EHSS parameters with the best effectiveness in evaluating the prognosis of EHS patients. As EHSS score increases, the mortality rate of EHS patients gradually increases.展开更多
In view of the enormous popularity of mass sporting events such as half-marathons, the number of patients with exertional rhabdomyolysis or exercise-induced heat stroke admitted to intensive care units(ICUs) has incre...In view of the enormous popularity of mass sporting events such as half-marathons, the number of patients with exertional rhabdomyolysis or exercise-induced heat stroke admitted to intensive care units(ICUs) has increased over the last decade. Because these patients have been reported to be at risk for malignant hyperthermia during general anesthesia, the intensive care community should bear in mind that the same risk of life-threatening rhabdomyolysis is present when these patients are admitted to an ICU, and volatile anesthetic sedation is chosen as the sedative technique. As illustrated by the three case studies we elaborate upon, a thorough diagnostic work-up is needed to clarify the subsequent risk of strenuous exercise, and the anesthetic exposure to volatile agents in these patients and their families. Other contraindications for the use of volatile intensive care sedation consist of known malignant hyperthermia susceptibility, congenital myopathies, Duchenne muscular dystrophy, and intracranial hypertension.展开更多
Heat stroke(HS)is a fatal disease caused by thermal damage in the body,and it has a very high mortality rate.In 2015,the People’s Liberation Army Professional Committee of Critical Care Medicine published the first e...Heat stroke(HS)is a fatal disease caused by thermal damage in the body,and it has a very high mortality rate.In 2015,the People’s Liberation Army Professional Committee of Critical Care Medicine published the first expert consensus on HS in China,Expert consensus on standardized diagnosis and treatment for heat stroke.With an increased understanding of HS and new issues that emerged during the HS treatment in China in recent years,the 2015 consensus no longer meet the requirements for HS prevention and treatment.It is necessary to update the consensus to include the latest research evidence and establish a new consensus that has broader coverage,is more practical and is more in line with China’s national conditions.This new expert consensus includes new concept of HS,recommendations for laboratory tests and auxiliary examinations,new understanding of diagnosis and differential diagnosis,On-site emergency treatment and In-hospital treatment,translocation of HS patients and prevention of HS.展开更多
Objective:To investigate the correlation between interleukin-6(IL-6),serum amyloid A(SAA),C-reactive protein(CRP)and exertional heat stroke in rats.Methods:A total of 90 adult Sprague-Dawley rats without specific path...Objective:To investigate the correlation between interleukin-6(IL-6),serum amyloid A(SAA),C-reactive protein(CRP)and exertional heat stroke in rats.Methods:A total of 90 adult Sprague-Dawley rats without specific pathogens were randomly divided into three groups:control group,classical group and exertion group,with 30 rats in each group.The control group was maintained at a temperature of(26±1)℃and humidity of(60±5)%,while the classical and exertion groups were exposed to a temperature of(40±0.5)℃and humidity of(70±5)%.Additionally,the exertion group underwent treadmill running under these conditions.The levels of IL-6,SAA,and CRP in the three groups were assessed and compared at various time points:before modeling,immediately after onset,and at 2,4,and 8 h after onset.Furthermore,Spearman correlation analysis was employed to examine.Results:The findings from the repeated measures analysis of variance indicated significant variations in the levels of IL-6,SAA,and CRP across the three groups(P<0.05).Both the classic and exertion groups exhibited higher levels of IL-6,SAA,and CRP compared to the control group,with the exertion group demonstrating even higher levels than the classic group(P<0.05).Additionally,Spearman correlation analysis revealed a positive correlation between the onset of heat stroke and the levels of IL-6,SAA,and CRP at the onset,as well as at 2,4,and 8 h post-onset(P<0.05).Furthermore,the types of heat stroke were found to be positively correlated with the levels of IL-6,SAA and CRP(P<0.05).Conclusion:The initiation and nature of heat stroke in rats are significantly associated with the concentrations of IL-6,SAA,and CRP.The concentrations of IL-6,SAA,and CRP within 8 h of onset can reliably forecast the occurrence of heat stroke in rats,serving as a basis for distinguishing classical heat stroke from exertional heat stroke.Nevertheless,the predictive and differentiating efficacy may diminish as the onset time prolongs.展开更多
基金supported by the National Natural Science Foundation of China (81671966)the Beijing Natural Science Foundation (7182155)+2 种基金the Application Research and Achievement Extension of Clinical Characteristics in Chinese Capital Foundation (Z171100001017160)the Cultivation Program for Military Medical Science and Technology Youth-Growth Project (16QNP139)the Clinical Research Support Foundation of Chinese PLA General Hospital (2015FC-ZHCG-1002)。
文摘Background: Heat stroke(HS) is a serious, life-threatening disease. However, there is no scoring system for HS so far. This research is to establish a scoring system that can quantitatively assess the severity of exertional heat stroke(EHS).Methods: Data were collected from a total of 170 exertional heat stroke(EHS) patients between 2005 and 2016 from 52 hospitals in China. Univariate statistical methods and comparison of the area under the receiver operating characteristic(ROC) curve(AUC) were used to screen exertional heat stroke score(EHSS) parameters, including but not limited body temperature(T), Glasgow Coma Scale(GCS) and others. By comparing the sizes of the AUCs of the APACHE II, SOFA and EHSS assessments, the effectiveness of EHSS in evaluating the prognosis of EHS patients was verified.Results: Through screening with a series of methods, as described above, the present study determined 12 parameters – body temperature(T), GCS, p H, lactate(Lac), platelet count(PLT), prothrombin time(PT), fibrinogen(Fib), troponin I(Tn I), aspartate aminotransferase(AST), total bilirubin(TBIL), creatinine(Cr) and acute gastrointestinal injury(AGI) classification – as EHSS parameters. It is a 0–47 point system designed to reflect increasing severity of heat stroke. Low(EHSS<20) and high scores(EHSS>35) showed 100% survival and 100% mortality, respectively. We found that AUCEHSS>AUCSOFA>AUCAPACHE II.Conclusions: A total of 12 parameters – T, GCS, p H, Lac, PLT, PT, Fib, Tn I, AST, TBIL, Cr and gastrointestinal AGI classification – are the EHSS parameters with the best effectiveness in evaluating the prognosis of EHS patients. As EHSS score increases, the mortality rate of EHS patients gradually increases.
文摘In view of the enormous popularity of mass sporting events such as half-marathons, the number of patients with exertional rhabdomyolysis or exercise-induced heat stroke admitted to intensive care units(ICUs) has increased over the last decade. Because these patients have been reported to be at risk for malignant hyperthermia during general anesthesia, the intensive care community should bear in mind that the same risk of life-threatening rhabdomyolysis is present when these patients are admitted to an ICU, and volatile anesthetic sedation is chosen as the sedative technique. As illustrated by the three case studies we elaborate upon, a thorough diagnostic work-up is needed to clarify the subsequent risk of strenuous exercise, and the anesthetic exposure to volatile agents in these patients and their families. Other contraindications for the use of volatile intensive care sedation consist of known malignant hyperthermia susceptibility, congenital myopathies, Duchenne muscular dystrophy, and intracranial hypertension.
文摘Heat stroke(HS)is a fatal disease caused by thermal damage in the body,and it has a very high mortality rate.In 2015,the People’s Liberation Army Professional Committee of Critical Care Medicine published the first expert consensus on HS in China,Expert consensus on standardized diagnosis and treatment for heat stroke.With an increased understanding of HS and new issues that emerged during the HS treatment in China in recent years,the 2015 consensus no longer meet the requirements for HS prevention and treatment.It is necessary to update the consensus to include the latest research evidence and establish a new consensus that has broader coverage,is more practical and is more in line with China’s national conditions.This new expert consensus includes new concept of HS,recommendations for laboratory tests and auxiliary examinations,new understanding of diagnosis and differential diagnosis,On-site emergency treatment and In-hospital treatment,translocation of HS patients and prevention of HS.
文摘Objective:To investigate the correlation between interleukin-6(IL-6),serum amyloid A(SAA),C-reactive protein(CRP)and exertional heat stroke in rats.Methods:A total of 90 adult Sprague-Dawley rats without specific pathogens were randomly divided into three groups:control group,classical group and exertion group,with 30 rats in each group.The control group was maintained at a temperature of(26±1)℃and humidity of(60±5)%,while the classical and exertion groups were exposed to a temperature of(40±0.5)℃and humidity of(70±5)%.Additionally,the exertion group underwent treadmill running under these conditions.The levels of IL-6,SAA,and CRP in the three groups were assessed and compared at various time points:before modeling,immediately after onset,and at 2,4,and 8 h after onset.Furthermore,Spearman correlation analysis was employed to examine.Results:The findings from the repeated measures analysis of variance indicated significant variations in the levels of IL-6,SAA,and CRP across the three groups(P<0.05).Both the classic and exertion groups exhibited higher levels of IL-6,SAA,and CRP compared to the control group,with the exertion group demonstrating even higher levels than the classic group(P<0.05).Additionally,Spearman correlation analysis revealed a positive correlation between the onset of heat stroke and the levels of IL-6,SAA,and CRP at the onset,as well as at 2,4,and 8 h post-onset(P<0.05).Furthermore,the types of heat stroke were found to be positively correlated with the levels of IL-6,SAA and CRP(P<0.05).Conclusion:The initiation and nature of heat stroke in rats are significantly associated with the concentrations of IL-6,SAA,and CRP.The concentrations of IL-6,SAA,and CRP within 8 h of onset can reliably forecast the occurrence of heat stroke in rats,serving as a basis for distinguishing classical heat stroke from exertional heat stroke.Nevertheless,the predictive and differentiating efficacy may diminish as the onset time prolongs.
文摘目的:分析血清肌酸激酶(CK)值作为劳力性热射病患者预后判别指标的意义。方法:回顾分析1995年9月-2007年8月6所部队医院的11例EHS病例。以预后为标准,将11例患者分为两组,死亡组(n=4)及存活组(n=7),比较两组病例入院后0 h、12 h、24 h、36 h、48 h、60 h、72 h的CK数值,并描绘48 h CK值的ROC曲线,分析CK值在发病早期判别预后的意义。结果:在入院后各时间点死亡组CK值持续升高,存活组CK值略升高后保持稳定并逐渐下降,两组CK值在48 h、60 h、72 h有显著差异(P<0.05),48 h CK值的ROC曲线AUC(area under the Roc curve)为0.893。结论:死亡患者与存活患者CK值的变化趋势显著不同,CK值可以在发病早期(48 h)判别预后。
