Shapiro Y, Seidman D S
Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer, Israel.
Med Sci Sports Exerc. 1990 Feb;22(1):6-14.
Exertional heatstroke (EH) occurs when heat production, generated by muscular exercise, exceeds the body's heat dissipation capacities. This illness has been reported among young, active individuals, laborers, and religious pilgrims. Although EH includes a rectal temperature above 39.5 degrees C (depending on the timing of the measurement) and elevation of serum enzymes, altered mental status is the universally accepted sign which distinguishes EH from heat exhaustion. Once EH is suspected, cooling therapy should be initiated immediately and investigation of multiple-system involvement should be undertaken. Delay in diagnosis occurs more commonly in moderate environments, when suspicion of EH is low. Complications of EH include the central nervous, cardiovascular, pulmonary, and gastrointestinal systems, often with renal and hematologic involvement. Treatment at the point of collapse should focus on clearing the airway, measurement of rectal temperature, whole body cooling, intravenous therapy, and prompt evacuation. Hospital treatment should emphasize whole body cooling, control of convulsions, monitoring of acid-base status, cardiac function, and renal function. The incidence of EH has been reduced markedly in Israel, by using the following simple guidelines: rest periods during exercise in heat, medical monitoring of strenuous activities, use of meteorological indices, and evaluation of medical history.
运动性中暑（EH）是指肌肉运动产生的热量超过人体散热能力时发生的情况。这种疾病在年轻、活跃的个体、劳动者和宗教朝圣者中都有报道。虽然运动性中暑包括直肠温度高于39.5摄氏度（取决于测量时间）和血清酶升高，但精神状态改变是将运动性中暑与热衰竭区分开来的普遍公认的标志。一旦怀疑发生运动性中暑，应立即开始降温治疗，并对多系统受累情况进行检查。诊断延迟在中等环境中更为常见，此时对运动性中暑的怀疑较低。运动性中暑的并发症包括中枢神经、心血管、肺和胃肠道系统，常伴有肾脏和血液系统受累。在中暑虚脱现场的治疗应着重于清理气道、测量直肠温度、全身降温、静脉治疗以及迅速转运。医院治疗应强调全身降温、控制惊厥、监测酸碱状态、心脏功能和肾功能。通过采用以下简单指南，以色列的运动性中暑发病率已显著降低：在高温环境下运动时休息、对剧烈活动进行医学监测、使用气象指标以及评估病史。
