熱中暑

Heat Stroke

王志強(Chich-Chiang Wang) ； 蔡明凱(Ming-Kai Tsai) ； 陳逸鴻(I-Hung Chen) ； 薛肇文(Chao-Wen Hsueh) ； 項正川(Jeng-Chuan Shiang)

《內科學誌》 19卷2期 (2008/04) Pp. 136-147

https://doi.org/10.6314/JIMT.2008.19(2).06

摘要

熱病(Heat-related illness)包括熱痙孿、熱暈厥、熱衰竭及熱中暑，熱衰竭可以經簡單的治療完全恢復，但若沒有適當的治療可能會演變成致命的熱中暑。熱中暑的定義為中心體溫大於40℃並合併中樞神經系統的異常，如譫妄、抽搐或昏迷。高熱會引起身體的急性生理變化及急性期反應(acute phase response)，造成體溫調節(Thermoregulation)功能失效，續發全身性發炎及血管內凝血反應。另外熱休克蛋白(heat-shock proteins)的減少及高熱本身對細胞的直接傷害，也促成了熱中暑的發生。決定中暑病患預後最重要關鍵其實是在病發後的前2個小時，快速且有效的降溫是治療熱中暑病患最首要的目標，若病患未能在2小時內得到適當的治療其預後是相當差的。了解熱中暑的臨床表現能幫助臨床醫師及早診斷，事實上簡單、實際可行的降溫方法如蒸發降溫、冰（冷）水浸浴就能有效的降低溫度。不過即使得到適當的治療仍有將近20％的病患會產生永久性的神經功能缺損，目前仍有許多新的治療方式在研究，希望未來能降低熱中暑的死亡率及併發症。

關鍵字

熱中暑

並列摘要

Heat-related illness includes heat cramps, heat syncope, heat exhaustion and heatstroke. Untreated heat exhaustion can progress to heatstroke, a life-threatening illness characterized by an elevated core body temperature (＞40℃) and dysfunction of central nervous system, which results in delirium, convulsions, or coma. Hyperthermia associated with the acute physiological alterations, thermoregulatory failure, systemic inflammatory response, attenuated heat-shock response and the cytotoxicity of heat leading to progression of heat stroke. The prognosis of heat stroke in patients is directly related to the duration of hyperthermia. The prognosis is poorest when treatment is delayed ＞2 hours. Therefore, the most important feature in the treatment of heat stroke is rapid cooling. The prognosis is optimal when heat stroke is diagnosed early and management with effective and easy cooling measures (including immersion in water, evaporative cooling) begins promptly. Long-term neurologic sequelae occur in approximately 20% of patients. New approaches to reduce mortality and complication of heat stroke are being studied.

並列關鍵字

Heat stroke