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中华重症医学电子杂志

中华重症医学电子杂志 ›› 2019, Vol. 05 ›› Issue (02) : 176 -184. doi: 10.3877/cma.j.issn.2096-1537.2019.02.017

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综述

重症中暑临床救治方法现状与研究进展
刘喆滢1, 吉晶晶1, 洪欣欣2, 苏磊3, 刘志锋3,†()   
  1. 1. 510010　广州，解放军南部战区总医院重症医学科；510515　广州，南方医科大学第一临床医学院
    2. 510010　广州，解放军南部战区总医院重症医学科；510006　广州，广州中医药大学研究生院
    3. 510010　广州，解放军南部战区总医院重症医学科
  • 收稿日期:2018-12-09 出版日期:2019-05-28
  • 通信作者: 刘志锋
  • 基金资助:
    国家自然科学基金项目(81571940，81741125); 广东省自然科学基金(2014A030313599); 广东省科技计划项目(2013B021800047); 广州市科技计划项目(201607010116); 军队后勤医学科研项目(CWH17L020，17CXZ008)

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

Zheying Liu1, Jingjing Ji1, Xinxin Hong2, Lei Su3, Zhifeng Liu3,†()   

  1. 1. Department of Critical Care Medicine, General Hospital of Southern Theatre Command of PLA, Guangzhou 510010, China; First Clinical Medical College of Southern Medical University, Guangzhou 510515, China
    2. Department of Critical Care Medicine, General Hospital of Southern Theatre Command of PLA, Guangzhou 510010, China; Graduate School of Guangzhou University of Chinese Medicine, Guangzhou 510006, China
    3. Department of Critical Care Medicine, General Hospital of Southern Theatre Command of PLA, Guangzhou 510010, China
  • Received:2018-12-09 Published:2019-05-28
  • Corresponding author: Zhifeng Liu
  • About author:
    Corresponding author: Liu Zhifeng, Email:
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引用本文：

刘喆滢, 吉晶晶, 洪欣欣, 苏磊, 刘志锋. 重症中暑临床救治方法现状与研究进展[J]. 中华重症医学电子杂志, 2019, 05(02): 176-184.

Zheying Liu, Jingjing Ji, Xinxin Hong, Lei Su, Zhifeng Liu. Current status and research progress of clinical management for severe heat stroke[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2019, 05(02): 176-184.

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。

关键词: 重症中暑, 临床救治, 现状与研究进展

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.

Key words: Severe heat stroke, Clinical treatment, Current situation, Research progress
1
苏磊. 重症中暑防治回顾与启示 [J]. 解放军医学杂志, 2011, 36(9):883-885.
2
Leon LR, Bouchama A. Heat stroke [J]. Compr Physiol, 2015, 5(2):611-647.
3
Liu Z, Zhong T, Zheng D, et al. Heat stress pretreatment decreases lipopolysaccharide-induced apoptosis via the p38 signaling pathway in human umbilical vein endothelial cells [J]. Mol Med Rep, 2016, 14(1):1007-1013.
4
Ji J, Gu Z, Li H, et al. Cryptdin-2 predicts intestinal injury during heatstroke in mice [J]. Int J Mol Med, 2018, 41(1):137-146.
5
Armstrong LE, Lee EC, Armstrong EM. Interactions of gut microbiota, endotoxemia, immune function, and diet in exertional heatstroke [J]. J Sports Med (Hindawi Publ Corp), 2018, 2018:5724575.
6
King MA, Leon LR, Morse DA, et al. Unique cytokine and chemokine responses to exertional heat stroke in mice [J]. J Appl Physiol (1985), 2017, 122(2):296-306.
7
周耿标，徐秋林，刘亚楠, 等. 乌司他丁对重症中暑小鼠急性肺损伤的保护作用 [J]. 南方医科大学学报, 2015, 35(9):1277-1282.
8
童华生，陈怿，唐柚青, 等. 乌司他丁对重症中暑患者血管内皮细胞损伤的保护作用 [J]. 广东医学, 2011, 32(12):1574-1576.
9
Tao Z, Hu FQ, Li CF, et al. Effect of ulinastatin, a human urinary protease inhibitor, on heatstroke-induced apoptosis and inflammatory responses in rats [J]. Exp Ther Med, 2017, 13(1):335-341.
10
Nakada H, Horie S, Kawanami S, et al. Development of a method for estimating oesophageal temperature by multi-locational temperature measurement inside the external auditory canal [J]. Int J Biometeorol, 2017, 61(9):1545-1554.
11
Nye EA, Edler JR, Eberman LE, et al. Optimizing cold-water immersion for exercise-induced hyperthermia: an evidence-based paper [J]. J Athl Training, 2016, 51(6):500-501.
12
Keen ML, Miller KC. Should cooling vests be used to treat exertional heatstroke? a critically appraised topic [J]. J Sport Rehabil, 2017, 26(3):286-289.
13
康春华. 冰毯机用于重度中暑患者降温效果观察 [J]. 实用临床医学, 2011, 12(9):117-118.
14
Hifumi T, Kondo Y, Shimizu K, et al. Heat stroke [J]. J Intensive Care, 2018, 6(1).
15
杨婉花，刘鸿翔，万晟霞, 等. 连续性血液滤过在重症中暑救治中的应用研究 [J]. 临床急诊杂志, 2016, 17(3):224-226.
16
Broessner G, Beer R, Franz G, et al. Case report: severe heat stroke with multiple organ dysfunction - a novel intravascular treatment approach [J]. Crit Care, 2005, 9(5):R498-R501.
17
Megarbane B, Resiere D, Delahaye A, et al. Endovascular hypothermia for heat stroke: a case report [J]. Intensive Care Med, 2004, 30(1):170.
18
Hamaya H, Hifumi T, Kawakita K, et al. Successful management of heat stroke associated with multiple-organ dysfunction by active intravascular cooling [J]. Am J Emerg Med, 2015, 33(1):124-125.
19
龚正，张凌云，王永全, 等. 连续性血液净化治疗重度中暑患者的临床研究 [J]. 内科急危重症杂志, 2017, 23(5):398-399.
20
胡玉艳，姜华，张晓明, 等. 乌司他丁对劳力型热射病患者血清IL-17、HS-CRP、cTnI、β2-MG及MODS的影响 [J]. 河南医学研究, 2015, 24(2):10-12.
21
陈玉兰，陈怿. 血必净注射液调控重症中暑单核细胞人白细胞DR抗原表达异常和血管内皮细胞损伤的效果 [J]. 中国医药导报, 2016, 13(10):11-14.
22
Lin YF, Liu TT, Hu CH, et al. Expressions of chemokines and their receptors in the brain after heat stroke-induced cortical damage [J]. J Neuroimmunol, 2018, 318:15-20.
23
倪啸晓，刘志锋，谢秋幼, 等. 中暑脑损伤机制及高压氧治疗作用的研究进展 [J]. 中华危重病急救医学, 2017, 29(6):572-576.
24
薛枫，吴伟翔，路敬叶, 等. 醒脑静注射液联合高压氧在中暑昏迷患者脑神经康复中的应用 [J]. 中西医结合心脑血管病杂志, 2015, 13(15):1776-1778.
25
包玉华，沈浩亮，王霆, 等. 醒脑静联合纳洛酮治疗重症中暑效果观察 [J]. 交通医学, 2014, 28(4):392-393.
26
韩玮，张秋灵，谢康民. 中暑的亚低温脑保护治疗 [J]. 临床神经病学杂志, 2009, 22(3):235-236.
27
Liska GM, Lippert T, Russo E, et al. A dual role for hyperbaric oxygen in stroke neuroprotection: preconditioning of the brain and stem cells [J]. Cond Med, 2018, 1(4):151-166.
28
田家林，张禹，杨晨, 等. 早期高压氧综合治疗对中暑昏迷患者的作用 [J]. 中国康复, 2010, 25(2):110-111.
29
Wu WS, Chou MT, Chao CM, et al. Melatonin reduces acute lung inflammation, edema, and hemorrhage in heatstroke rats [J]. Acta Pharmacol Sin, 2012, 33(6):775-782.
30
万鹏，童华生，张兴钦, 等. Sonoclot分析仪在重症中暑并发弥散性血管内凝血中的诊断价值 [J]. 实用医学杂志, 2014, 30(16):2562-2565.
31
周杰，刘文明，蒋建红, 等. 重症中暑患者合并弥散性血管内凝血的临床分析 [J]. 右江医学, 2011, 39(3):263-265.
32
殷惠梅，陆勇，施学智, 等. 重症中暑大鼠血小板计数和功能动态变化研究 [J]. 解放军医学杂志, 2018, 43(5):398-402.
33
叶珏明，封启明，陶宝华. 乌司他丁应用于中暑患者的疗效评价 [J]. 世界临床药物, 2009, 30(3):170-171.
34
卢博. 连续性血液净化联合乌司他丁治疗热射病的疗效分析 [J]. 中华全科医学, 2013, 11(11):1696-1697.
35
郑琦涵，赵晓成，徐进, 等. 普通肝素治疗重度中暑合并凝血功能障碍的疗效 [J]. 中华卫生应急电子杂志, 2017, 3(6):365-366.
36
Yu Y, Wei Y, Zhang X, et al. Effect of early intervention with heparin on function of coagulopathy, liver and kidney in rats with exertional heatstroke under the ambient air of high temperature and low humidity [J]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 2018, 30(3):214-219.
37
孙海伟，赵益明，王卫广, 等. 低分子肝素对重症中暑合并凝血功能异常的疗效观察 [J]. 苏州大学学报(医学版), 2011, 31(5):818-820.
38
Hirsh J, Raschke R. Heparin and low-molecular-weight heparin: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy [J]. Chest, 2004, 126(3 Suppl):S188-S203.
39
孙海伟，赵益明，王卫广, 等. 低分子肝素在重症中暑合并凝血异常中的早期运用 [J]. 临床荟萃, 2012, 27(1):69-71.
40
Pechlaner C, Kaneider NC, Djanani A, et al. Antithrombin and near-fatal exertional heat stroke [J]. Acta Med Austriaca, 2002, 29(3):107-111.
41
Hagiwara S, Iwasaka H, Shingu C, et al. High-dose antithrombin Ⅲ prevents heat stroke by attenuating systemic inflammation in rats [J]. Inflamm Res, 2010, 59(7):511-518.
42
Vincent JL, Ramesh MK, Ernest D, et al. A randomized, double-blind, placebo-controlled, Phase 2b study to evaluate the safety and efficacy of recombinant human soluble thrombomodulin, ART-123, in patients with sepsis and suspected disseminated intravascular coagulation [J]. Crit Care Med, 2013, 41(9):2069-2079.
43
Hagiwara S, Iwasaka H, Goto K, et al. Recombinant thrombomodulin prevents heatstroke by inhibition of high-mobility group box 1 protein in sera of rats [J]. Shock, 2010, 34(4):402-406.
44
韩小彤. 连续性肾脏替代疗法治疗重症热射病合并多器官功能障碍综合征30例临床分析 [J]. 中国基层医药, 2011, 18(14):1953-1954.
45
庄永泽，魏丽芳，赖国祥, 等. 重症中暑患者急性肾损害的临床分析 [J]. 中国中西医结合肾病杂志, 2009, 10(2):134-136.
46
荣鹏，孟建中，陈宇. 热射病的发病机制及防治策略的研究新进展 [J]. 生物医学工程研究, 2010, 29(4):287-292.
47
程书立，许继元，李家琼, 等. CRRT治疗重症中暑伴横纹肌溶解肾功能不全患者的临床评价 [J]. 中国现代医学杂志, 2013, 23(32):96-99.
48
苏磊，孟繁甦，刘志锋, 等. 重症中暑合并横纹肌溶解综合征患者3种炎症介质的初步分析 [J]. 中国危重病急救医学, 2008, 20(11):699-700.
49
郭涛，童华生. CRRT在重症中暑并发横纹肌溶解综合征患者的应用及护理 [J]. 中国急救复苏与灾害医学杂志, 2017, 12(4):369-371.
50
Chen GM, Chen YH, Zhang W, et al. Therapy of severe heatshock in combination with multiple organ dysfunction with continuous renal replacement therapy: a clinical study [J]. Medicine (Baltimore), 2015, 94(31):e1212.
51
王剑，周亚静. 乌司他丁辅助CRRT治疗重症横纹肌溶解综合征合并急性肾损伤的临床效果观察 [J]. 广西医科大学学报, 2018, 35(4):522-525.
52
潘志国，邵玉，陈怿, 等. 乌司他丁对甘油诱导横纹肌溶解大鼠IL-6、TNF-α释放的影响及其对横纹肌的保护作用 [J]. 解放军医学杂志, 2014, 39(2):105-108.
53
Inayat F, Virk HU. Liver transplantation after exertional heatstroke-induced acute liver failure [J]. Cureus, 2016, 8(9):e768.
54
吉晶晶，李俊，李慧, 等. 乌司他丁对重症中暑小鼠心功能损害的保护作用及机制研究 [J]. 解放军医学杂志, 2017, 42(4):290-294.
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