重症中暑致多器官功能障碍综合征18例临床分析

陈中珍; 陆件; 许晓文; 沈奕; 庄智伟; 吴思荣; 陆士奇

doi:10.7619/jcmp.201917005

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 patients with multiple organ dysfunction syndrome caused by severe heat stroke

摘要

摘要:
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。
方法回顾性分析18例重症中暑致MODS患者临床资料以及实施集束化治疗的措施, 观察临床疗效。
结果所有患者均表现为高热，平均体温(40.50±1.80) ℃, 白细胞计数(WBC)、C反应蛋白(CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)等炎症指标明显升高，异常率65%以上, 15例符合全身炎症反应综合征(SIRS); 凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)明显延长, D-二聚体明显升高，异常率80%以上; 共累及受损器官70个，循环系统、肾脏、凝血系统居前3位。给予集束化治疗后，患者脏器功能障碍多能及时逆转，恢复较快。
结论热损伤、SIRS和凝血功能异常等多个机制参与了重症中暑的病理生理过程，集束化治疗疗效显著。

Abstract:
Objective To analyze the clinical features of patients with multiple organ dysfunction syndrome (MODS) caused by severe heat stroke.
Methods Clinical data and measures for cluster therapy of 18 patients with MODS caused by severe heat stroke were retrospectively analyzed, and clinical efficacy was observed.
Results All the patients were characterized by high fever, the average temperature was (40.5±1.8) ℃, and inflammatory indicators such as white blood cell count (WBC), C reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) significantly increased with an abnormal rate over 65%. Fifteen patients met the criteria of systemic inflammatory response syndrome (SIRS), prothrombin time (PT) and activated partial thromboplastin time (APTT) significantly prolonged, D-Dimer level significantly increased, and the abnormal rate was more than 80%. A total of 70 injured organs were involved, and the circulatory system, kidney and coagulation system ranked the top three. After implementation of cluster therapy, the patients′organ dysfunction can be reversed in time and recovered quickly.
Conclusion Several mechanisms, such as heat injury, SIRS and coagulation dysfunction, are involved in the pathophysiological process of severe heat stroke. Cluster therapy is effective.

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