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目的:分析因军事训练致劳力性热射病(EHS)的发病原因及临床表现。方法:回顾性分析2012年1月—2016年6月共14例EHS患者的临床资料,考察其发病影响因素和临床表现。结果结果:补水不够、睡眠不足和存在诱发疾病是EHS发病的最常见易感因素;患者在病程中出现意识障碍、弥散性血管内凝血、多脏器功能障碍综合征和横纹肌溶解等症状。入院时均存在电解质紊乱,血清钾(K~+)均高出正常范围,钠(Na~+)、氯(Cl~-)则均偏低;丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)异常升高,AST尤其明显,胆红素升高幅度不大;尿素氮(BUN)和肌酐(Cr)升高幅度较大,尿酸(UA)的异常表现相对不明显;肌酸肌酶(CK)、乳酸脱氢酶(LDH)入院时异常病例数较少,两天后明显增加,发生横纹肌溶解的患者CK升高幅度可达十余倍,并伴肌红蛋白尿,肌酸激酶同工酶MB(CKMB)异常表现相对不明显,肌红蛋白(Mb)始终处于高位,且均有十倍以上升高。活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)和凝血酶时间(TT)均延长,纤维蛋白原(FIB)降低;白细胞(WBC)、红细胞(RBC)升高。结论:军事训练中应针对发病因素加强EHS的预防,在EHS治疗中应密切关注患者的特征性表现。
Objective: To analyze the etiology and clinical manifestations of labor-induced heat stroke (EHS) due to military training. Methods: The clinical data of 14 patients with EHS from January 2012 to June 2016 were retrospectively analyzed to investigate the influencing factors and clinical manifestations of EHS. Results: Insufficient hydration, lack of sleep, and presence of predisposition to disease were the most common predisposing factors for EHS. Patients suffered from disturbance of consciousness, disseminated intravascular coagulation, multiple organ dysfunction syndrome and rhabdomyolysis during the course of their illness. There were electrolyte imbalances on admission, serum potassium (K ~ +) were higher than the normal range, sodium (Na ~ +) and chloride (Cl ~ -) were lower; alanine aminotransferase (ALT) and aspartate The levels of AST, AST and bilirubin were not significantly increased. The levels of BUN and Cr increased significantly, while the abnormalities of UA were relatively insignificant. Creatine Creatinine (CK) and lactate dehydrogenase (LDH) were less frequently admitted to hospital and increased significantly after two days. Patients with rhabdomyolysis had an increase of more than ten folds of CK, accompanied by an increase in myoglobinuria, creatine kinase The abnormal expression of isoenzyme MB (CKMB) was relatively insignificant, myoglobin (Mb) was always high, and all ten times higher than those of CKMB. Activated partial thromboplastin time (APTT), prothrombin time (PT) and thrombin time (TT) were prolonged, fibrinogen (FIB) decreased; white blood cells (WBC), red blood cells (RBC) increased. Conclusion: EHS prevention should be strengthened for the risk factors in military training. The characteristics of patients should be closely monitored during EHS treatment.