劳力性热射病并发弥散性血管内凝血的治疗

王全顺; 周飞虎; 潘亮; 宋青

doi:10.13201/j.issn.1004-2806.2012.02.022

劳力性热射病并发弥散性血管内凝血的治疗

- 1 中国人民解放军总医院血液科(北京, 100853);
- 2 中国人民解放军总医院重症监护科

详细信息

通讯作者: 王全顺,E-mail:wqs63@sohu.com

中图分类号: R554

收稿日期: 2011-05-18

修回日期: 2011-07-18

Treatment of disseminated intravascular coagulation as a complication of exertional heat stroke

- 1. Department of Hematology, Chinese PLA General Hospital, Beijing, 100853, China;
- 2. Department of Surgical Intensive Care Unit of Chinese PLA General Hospital

More Information

Corresponding author: WANG Quanshun, E-mail: wqs63@sohu.com

Received Date: 18 May 2011

Revised Date: 18 July 2011

摘要

摘要: 目的:就我们2005年以来收治的并发有弥散性血管内凝血、多器官功能障碍综合征的严重劳力性热射病进行总结。方法:共6例重症热射病患者,每日监测全血细胞计数、血生化、肌酸激酶、血/尿肌红蛋白浓度及凝血功能等指标。治疗:快速降温、大量输液改善微循环、连续血液净化等支持治疗。DIC治疗:补充凝血因子,低分子肝素抗凝。全部6例中仅例1治疗过程未使用肝素。结果:所有患者在起病3~30 h住院,表现为意识障碍、昏迷、低血压、休克、皮肤及黏膜出血。实验室检查:血小板计数呈进行性下降,最低值(3.0~3.4)×10⁹/L,均有转氨酶、总胆红素和直接胆红素、血肌酐、肌红蛋白升高,起病72 h左右达到高峰。随着治疗大多在2~3周后恢复正常。全部患者入院时D-二聚体均已升高,起病6 h后纤维蛋白原水平低于正常,PT、APTT延长,均符合弥散性血管内凝血诊断。凝血功能在1~4周恢复正常。例1治疗中未用肝素,最终死于多器官功能衰竭及弥散性血管内凝血。结论:连续血液净化可以有效清除肌红蛋白、炎性递质等代谢产物,迅速纠正电解质及酸碱失衡,同时起到补充液体及凝血因子的作用。使用肝素抑制过度活跃的凝血系统,阻止微血栓的形成,对于改善组织缺血和缺氧、治疗弥散性血管内凝血、多器官功能障碍综合征,提高治愈率起到关键的作用。
- 劳力性热射病 /
- 弥散性血管内凝血 /
- 多器官功能衰竭 /
- 横纹肌溶解 /
- 连续血液净化
Abstract: Objective:We summarize the clinical findings and treatments in a series patient with exertional heat stroke (EHS).Method: Six patients with EHS complicated with multiple organ failure syndrome,rhabdomyolysis and disseminated intravascular coagulation (DIC) were studied retrospectively. The measurements included whole blood cell count,hepatic function,renal function,electrolytes,creatine kinase,serum/urinary myoglobin levels and coagulatory function. The treatments included endotracheal intubation, mechanical ventilation,cooling,transfusion,blood purification,intensive supportive measures and supplement of coagulation factors. All patients except one received heparin or low-molecular weight heparin for the treatment of DIC.Result::All patients had elevated ALT,AST,CK,myoglobin, and creatinine levels. Coagulatory abnormalities were universal. Continuous blood purification and the treatment of DIC with heparin could effectually improve the prognosis of EHS.Conclusion:EHS always occurrs with rhabdomyolysis,renal dysfunction and DIC. Blood purification and heparin for anti-coagulation treatment both play significant role in the treatment of EHS.
- exertional heat stroke /
- disseminated intravascular coagulation /
- multiple organ failure syndrome /
- rhabdomyolysis /
- continuous blood purification

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