Bouchama Abderrezak, Dehbi Mohammed, Chaves-Carballo Enrique
Department of Comparative Medicine MBC-03, King Faisal Specialist Hospital & Research Centre, P,O, Box 3354, Riyadh 11211, Saudi Arabia.
Crit Care. 2007;11(3):R54. doi: 10.1186/cc5910.
Although rapid cooling and management of circulatory failure are crucial to the prevention of irreversible tissue damage and death in heatstroke, the evidence supporting the optimal cooling method and hemodynamic management has yet to be established.
A systematic review of all clinical studies published in Medline (1966 to 2006), CINAHL (Cumulative Index to Nursing & Allied Health Literature) (1982 to 2006), and Cochrane Database was performed using the OVID interface without language restriction. Search terms included heatstroke, sunstroke, and heat stress disorders.
Fourteen articles reported populations subjected to cooling treatment for classic or exertional heatstroke and included data on cooling time, neurologic morbidity, or mortality. Five additional articles described invasive monitoring with central venous or pulmonary artery catheters. The four clinical trials and 15 observational studies covered a total of 556 patients. A careful analysis of the results obtained indicated that the cooling method based on conduction, namely immersion in iced water, was effective among young people, military personnel, and athletes with exertional heatstroke. There was no evidence to support the superiority of any one cooling technique in classic heatstroke. The effects of non-invasive, evaporative, or conductive-based cooling techniques, singly or combined, appeared to be comparable. No evidence of a specific endpoint temperature for safe cessation of cooling was found. The circulatory alterations in heatstroke were due mostly to a form of distributive shock associated with relative or absolute hypovolemia. Myocardial failure was found to be rare.
A systematic review of the literature failed to identify reliable clinical data on the optimum treatment of heatstroke. Nonetheless, the findings of this study could serve as a framework for preliminary recommendations in cooling and hemodynamic management of heatstroke until more evidence-based data are generated.
尽管快速降温及循环衰竭的处理对于预防中暑时不可逆的组织损伤和死亡至关重要，但支持最佳降温方法及血流动力学管理的证据尚未确立。
使用OVID界面，对发表于Medline（1966年至2006年）、CINAHL（护理及相关健康文献累积索引）（1982年至2006年）及Cochrane数据库的所有临床研究进行系统综述，无语言限制。检索词包括中暑、日射病及热应激障碍。
14篇文章报道了经典型或劳力性中暑接受降温治疗人群的数据，包括降温时间、神经并发症或死亡率。另外5篇文章描述了使用中心静脉或肺动脉导管进行的有创监测。4项临床试验及15项观察性研究共纳入556例患者。对所得结果的仔细分析表明，基于传导的降温方法，即浸入冰水中，对劳力性中暑的年轻人、军人及运动员有效。没有证据支持在经典型中暑中任何一种降温技术具有优越性。单独或联合使用的无创、蒸发或基于传导的降温技术效果似乎相当。未发现有安全停止降温的特定终点温度的证据。中暑时的循环改变主要是一种与相对或绝对血容量不足相关的分布性休克形式所致。发现心肌衰竭罕见。
对文献的系统综述未能找到关于中暑最佳治疗的可靠临床数据。尽管如此，本研究结果可作为中暑降温及血流动力学管理初步建议的框架，直至产生更多循证数据。
