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3～30h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72h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6h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。 OBJECTIVE: To summarize the severe labor-induced ther- apy disease that has been complicated with disseminated intravascular coagulation and multiple organ dysfunction syndrome since 2005. Methods: A total of 6 patients with severe heat-induced fever were enrolled in the study. Blood count, blood biochemistry, creatine kinase, blood / urine myoglobin and coagulation were monitored daily. Treatment: rapid cooling, a large infusion to improve microcirculation, continuous blood purification and other supportive treatment. DIC treatment: supplementary coagulation factor, low molecular weight heparin anticoagulation. Only 1 of 6 cases did not use heparin during the course of treatment. Results: All patients were hospitalized 3 ~ 30h after onset, manifested as disturbance of consciousness, coma, hypotension, shock, skin and mucous membrane hemorrhage. Laboratory tests: Platelet count showed a progressive decline, the lowest value (3.0 ~ 3.4) × 109 / L, both transaminases, total bilirubin and direct bilirubin, serum creatinine, myoglobin increased, onset of about 72h Peak. With the treatment mostly in 2 to 3 weeks to return to normal. D-dimer was increased in all patients admitted to hospital, 6 hours after onset of fibrinogen levels lower than normal, PT, APTT extended, are in line with diffuse intravascular coagulation diagnosis. Coagulation in 1 to 4 weeks to return to normal. Example 1 Heparin was not used during treatment and eventually died of multiple organ failure and disseminated intravascular coagulation. CONCLUSION: Continuous blood purification can effectively remove myoglobin, inflammatory mediators and other metabolites, quickly correct the electrolyte and acid-base imbalance, and at the same time play a role in replenishing fluid and blood coagulation factors. The use of heparin to inhibit the hyperactivity of the coagulation system and prevent the formation of microthrombi plays a key role in improving tissue ischemia and hypoxia, treating disseminated intravascular coagulation, multiple organ dysfunction syndrome and improving the cure rate.