熱中暑之持久性神經後遺症－二病例報告

熱中暑是一種系統性急症，死亡率高達17－70%，可造成很多器官障礙及後遺症，關於神經系統障礙，幾乎是短暫的，造成持久性神經性障礙則極少。本院自民國65年7月至74年9月間，熱中暑患者共計99人，死亡人數為20人，死亡率為20.2%。產生的神經性症狀幾乎是可恢復的，僅有二例有持久性神經後遺症。若排除死亡人數，其發生率為2.53%。病例一之持久性神經後遺症主要以小腦功能障礙及上運動神經元障礙為主；病例二主要以小腦功能障礙及上運動神經元障礙為主，和輕微大腦皮質功能障礙。其致病因主要是與血液循環不足、直接熱傷害、顱內壓高及腦水腫有關，而造成腦病變。其中小腦病變最為顯著，小腦病理發現是Purkinje細胞產生退化性病變。治療方針是儘快降低體温，減低腦水腫及顱內高壓。

關鍵字

熱中暑； Purkinje細胞變性

並列摘要

The heat stroke is a systemic catastrophic disorder characterized by hyperpyrexia, delirium, coma and anhidrosis. The mortality is 10-70%. The neurological disorder is almost transient. The persistent neurological sequela is very rare. From July, 1976 to Sept. 1985, ninety-nine cases of heat stroke were collected in the Department of Nephrology, T.S.G.H. Only two cases had the persistent neurological sequela. Its incidence was 2.53% (death cases excluded). The persistent neurological sequela in case 1 revealed cerebellar syndrome and upper motor neuron disorder. Case 2 revealed cerebellar syndrome, upper motor neuron disorder, and minimal cortical dysfunction. The pathogenesis may be due to vascular insufficiency, direct thermal damage, intracranial hypertension and brain edema. The cerebelIar damage is the most important finding which has Purkinje cell degeneration in histopathological examination. The main principles of therapy are to decrease high temperature, brain edema and intracranial hypertension.

並列關鍵字

Heat stroke ； Purkinje cell degeneration

國際替代計量

熱中暑之持久性神經後遺症－二病例報告

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