- 期刊
閃電擊傷：病理生理學、臨床治療與預防措施
Lightning Injury-Pathophysiology, Treatment and Prevention
摘要
古老的傳說讓我們將閃電擊傷與“天譴”聯想在一起。閃電是一種天候與地形配合，自然形成的放電現象。電壓可達10-100萬伏特，0.1-0.001秒的時問便可從雲層傳至地表，且能造成數千度以上的高溫。閃電擊傷的發生率目前我國並無確實統計資料，在美國，較新的文獻記錄每年約1000-1500人遭閃電擊傷，而死亡率約1/3。存活者有75%會有程度不一的後遺症（神經症狀、耳聽力或平衡障礙等）。本文藉由三位農夫遭到閃電擊傷且存活的報告，將回顧文獻資料，除針對閃電物理學、閃電擊傷的病理生理學及臨床治療加以討論外，每逢雷雨季節，希望能提醒位在山區、曠野，或常從事戶外活動者（高爾夫球、露營、農夫等），密切注意天氣預報及閃電擊傷的預防的措施。而對於閑電擊中昏厥的患者要施予立即且持續的心肺復甦是我們所強調的。
並列摘要
Lightning injury is always considered as natural electrocution traditionally. In fact, with its rarity, most physicians never see or treat such a victim. There was no definite official statistical data reported in Taiwan. Estimates are that approximately 1000-1500 persons were struck by lightning annually in the U.S. Mortality is about 1/3 of these victims although it was generally believed that this injury was nearly uniformly fatal in the past. Up to 75% of the survivors have permanent sequelae was reported. We present three survival cases (2 male, 1 female, 28-58 years old) who had been struck by lightning at the same day. They suffered from some superficial dermal burn wound, ranged from 3-12% TBSA, and associated with various systemic injuries. Their hospital course and results of follow-up is presented. The physics of lightning production, types of lightning injuries is reviewed that are well understood today. We also discuss its pathophysiology and medical consequences, include cardiopulmonary, neuropsychiatric, musculoskeletal, cutaneous thermal injury etc. Pre-hospital and clinical managements is discussed. Prompt and prolonged CPR is key to the resuscitation. The ways of prevention from this injury are recommended.