重症中暑患者合并弥散性血管内凝血的临床分析(1)
 |
| 第1页 |
参见附件(3198KB，5页)。
【摘要】 目的 探讨重症中暑患者弥散性血管内凝血(DIC)的发生率、影响因素、合并症及治疗。
方法 回顾性分析我院收治的57例重症中暑患者的临床资料与救治经验。结果 单因素分析显示重症中暑患者并发DIC与高温暴露时间、体温、休克关系密切，与性别、年龄无关，且发生DIC的重症中暑患者合并肝功能异常、横纹肌溶解发生率明显升高。经降温、抗休克、脏器支持等综合治疗，有5例患者死亡，治疗有效率为91.2%，其中合并DIC的患者病死率为18.2%。结论 重症中暑患者合并DIC病死率高，采取集束化救治技术，控制性降温、积极抗休克和脏器保护，可有效提高抢救重症中暑患者的成功率，在DIC抗凝治疗同时需注意保护肝肾功能。
【关键词】 重症中暑;弥散性血管内凝血(DIC);集束化治疗
文章编号：1003-1383(2011)03-0263-03 中图分类号：R 594.1+2 文献标识码：A
doi:10.3969/j.issn.1003-1383.2011.03.004
Clinical analysis of severe heat stroke with DIC
ZHOU Jie，LIU Wenming，JIANG Jianhong，YANG Qiaoyun
(ICU Department of No.2 People's Hospital of Changzhou，Changzhou 213003，Jiangsu Province)
【Abstract】 Objective To study the incidence, influence factors, complications and treatment of severe heat stroke with Disseminated Intravascular Coagulation (DIC).
Methods A review analysis of the clinical data and treatments of 57 severe heat stroke patients in our hospital was made.
Results The univariate analysis indicated that severe heat stroke with DIC was closely related with the time of high temperature exposure，body temperature and shock,not with sex and age,and there also appeared abnormal liver function and an apparent rise in the incidence of striated muscle dissolution.By comprehensive treatments such as cooling，anti-shock and viscera support，only 5 patients failed to survive，and the cure rate was 91.2%.The death rate of the patients with DIC was 18.2%.
Conclusion It suggests a high death rate in severe heat stroke with DIC.Bundle treatment,temperature control, active anti-shock and viscera protection can enhance the success of the treatment of severe heat stroke.The protection of liver and kidney function shouldn't be neglected during the DIC anticoagulant treatment.
【Key words】severe heatstroke; disseminated intravascular coagulation (DIC); bundle treatment
中暑是在高温环境下，机体由于产热与散热失衡，体温中枢调节功能障碍，汗腺功能衰竭，电解质紊乱，内皮功能异常等引起的一系列综合征。依据症状轻重分为先兆中暑、轻症中暑及重症中暑。重症中暑按发病机制分热痉挛、热衰竭和热射病。而重症中暑并发症多，病死率明显升高。中暑引起的急性肝功能衰竭和DIC是最严重的并发症之一。本文通过总结我院2005年7月至2010年8月收治的57例重症中暑患者(其中有22例并发DIC)的临床资料，分析重症中暑患者DIC的临床特点和集束化治疗。
资料与方法
1.病例资料 收集急诊病区2005年7月～2010年8月重症中暑病例共57例，其中男性39例，女性18例，年龄(42±25)岁，重症中暑及DIC的诊断标准依据我国《职业性中暑诊断标准》(GBI 1508-89)[1 ......
您现在查看是摘要介绍页，详见PDF附件(3198KB，5页)。