Day T K, Grimshaw D
TPMH, RAF Akrotiri.
J R Army Med Corps. 2005 Mar;151(1):11-8. doi: 10.1136/jramc-151-01-03.
During operations in subtropical areas over the summer months of 2001 and 2003 the authors audited 80 patients with heat-related illness, with the intention of defining the nature and distribution of the underlying pathophysiology. Haematological, biochemical and clinical data were gathered prospectively and patients allocated to diagnostic categories on the basis of the combination of clinical findings and investigations. Four basic types of heat-related illness could be distinguished: (1) excessive salt loss with hyponatraemic dehydration, (2) hypokalaemic alkalosis with low serum bicarbonate, (3) haemodilution associated with excessive water intake in stressed individuals, and (4) loss of normal thermoregulation, characterised by high core temperature and paradoxical cessation of sweating. Most of the patients fell clearly into a single distinct category, but there was a degree of overlap. Reduction of extracellular fluid volume was a common central mechanism. Common provoking factors identified were: gastrointestinal upset, history of previous heat intolerance (35%) environmental temperatures exceeding 45 degrees C, short period of acclimatisation (55%), travel, sleep loss, hard physical work especially if directly preceded by a period of sleep, work in confined humid spaces (45%), and lack of additional salt intake. When several of these factors were present together admission rate over one 24-hour period reached 3% of persons at risk per day. Patients are often more ill than they appear. To reduce the incidence of heat illness during future operations the following measures are proposed: 1. Avoidance of physical exertion during the heat of the day for the first 7-10 days. 2. Progressive gentle exercise in the early morning or late evening over the same period. 3. Increase in daily salt intake to 15-20gm for the first 2-3 weeks. 4. Only sufficient water intake to relieve thirst and to ensure the flow of abundant dilute urine.
在2001年和2003年夏季的亚热带地区行动期间，作者对80例中暑患者进行了审计，目的是确定潜在病理生理学的性质和分布。前瞻性收集血液学、生化和临床数据，并根据临床发现和检查结果将患者分类诊断。可以区分出四种基本类型的中暑：（1）伴有低钠血症性脱水的过度盐分流失；（2）血清碳酸氢盐水平低的低钾性碱中毒；（3）应激个体因过量饮水导致的血液稀释；（4）正常体温调节功能丧失，表现为核心体温升高和出汗反常停止。大多数患者明显属于单一类别，但存在一定程度的重叠。细胞外液量减少是一个常见的核心机制。确定的常见诱发因素包括：胃肠道不适、既往耐热性差病史（35%）、环境温度超过45摄氏度、适应期短（55%）、旅行、睡眠不足、重体力劳动（尤其是紧接一段睡眠之前）、在密闭潮湿空间工作（45%）以及缺乏额外盐分摄入。当这些因素中的几种同时存在时，在一个24小时期间，高危人群的入院率达到每天3%。患者往往比看上去病情更严重。为降低未来行动期间中暑的发生率，建议采取以下措施：1. 在最初7至10天内避免在白天炎热时段进行体力活动。2. 在同一时期的清晨或傍晚进行渐进性轻度运动。3. 在最初2至3周内将每日盐分摄入量增加至15至20克。4. 仅摄入足够的水以解渴并确保大量稀释尿液的排出。
