摘要热射病定义为核心体温＞40 ℃并伴有意识障碍的疾病,可分为劳力性热射病(EHS)和经典型热射病(CHS).近年来,EHS发病率呈逐年上升趋势,其病情严重程度及临床预后与热暴露时间下曲线面积呈正相关,在降温的"黄金30 min"内将核心体温降至38.9 ℃能降低患者的病死率、获取最佳临床预后.EHS最佳的降温方案是冰水浸润,也可选择其他替代方法如20 ℃以下水浸润、振荡冰水浸润降温、降温单元、去除衣物、移至空调房间、全身和大动脉覆盖冰块降温、按摩保证皮肤血流灌注量等;输注冷盐水也是备选的降温方法,尤其适用于伴有脱水者.降温结束后需继续监测核心体温,以避免降温后低体温或再发热,积极处置可能出现的寒战、激越等不良反应.本文通过对EHS的院前识别、评估和监护、快速降温救治措施进行综述,以期为EHS早期识别与科学合理有效的降温治疗提供参考.

abstractsHeat stroke (HS) is a life-threatening illness characterized by an altered level of consciousness with an elevated core body temperature 40 ℃, which may be further classified as exertional heat stroke (EHS) or classical heat stroke (CHS) according to the etiology of the condition. In recent years, the morbidity of EHS increases year by year. The severity and clinical outcome for an EHS casualty have a strong correlation with the area under the time and temperature curve for heat exposure. The early recognition and rapid cooling body core temperature ≤38.9 ℃ within 30 minutes of EHS results in the best clinical outcome and minimize severe multiple organ dysfunction and death for patients. Cold water immersion (CWI) is considered as an optimum cooling method for the reversal of hyperthermia in EHS. Some alternative modalities have also shown acceptable cooling rate, for example, the subjects immersed in a circulated water bath controlled below 20 ℃, tarp-assisted cooling with oscillation, body cooling unit, undressed, air-conditioned room, the whole body and large vessels placed ice packs, massaging the extremities; cold intravenous saline applied to dehydrated one. It is necessary to monitor body core temperature for hypothermia and/or recurrent hyperthermia, and to provide physical care for shivering, agitation, or concerns with the potential discomfort combativeness that may occur during cooling process. In this paper, pre-hospital recognition, care, monitoring and rapid cooling treatment measures of EHS have been reviewed to provide references for early identification of EHS and scientific, reasonable and effective cooling treatment.