Gaudio Flavio G, Grissom Colin K
Division of Emergency Medicine, New York Presbyterian Hospital - Weill Cornell Medical Center, New York, New York.
Critical Care Medicine, Intermountain Medical Center, Murray, Utah.
J Emerg Med. 2016 Apr;50(4):607-16. doi: 10.1016/j.jemermed.2015.09.014. Epub 2015 Oct 31.
Heat stroke is an illness with a high risk of mortality or morbidity, which can occur in the young and fit (exertional heat stroke) as well as the elderly and infirm (nonexertional heat stroke). In the United States, from 2006 to 2010, there were at least 3332 deaths attributed to heat stroke.
To summarize the available evidence on the principal cooling methods used in the treatment of heat stroke.
Although it is generally agreed that rapid, effective cooling increases survival in heat stroke, there continues to be debate on the optimal cooling method. Large, controlled clinical trials on heat stroke are lacking. Cooling techniques applied to healthy volunteers in experimental models of heat stroke have not worked as rapidly in actual patients with heat stroke. The best available evidence has come from large case series using ice-water immersion or evaporation plus convection to cool heat-stroke patients.
Ice-water immersion has been shown to be highly effective in exertional heat stroke, with a zero fatality rate in large case series of younger, fit patients. In older patients with nonexertional heat stroke, studies have more often promoted evaporative plus convective cooling. Evaporative plus convective cooling may be augmented by crushed ice or ice packs applied diffusely to the body. Chilled intravenous fluids may also supplement primary cooling. Based on current evidence, ice packs applied strategically to the neck, axilla, and groin; cooling blankets; and intravascular or external cooling devices are not recommended as primary cooling methods in heat stroke.
中暑是一种具有高死亡率或发病率的疾病，可发生于年轻人和健康者（劳力性中暑）以及老年人和体弱者（非劳力性中暑）。在美国，2006年至2010年期间，至少有3332例死亡归因于中暑。
总结治疗中暑时主要降温方法的现有证据。
尽管人们普遍认为快速、有效的降温可提高中暑患者的生存率，但对于最佳降温方法仍存在争议。缺乏关于中暑的大型对照临床试验。在中暑实验模型中应用于健康志愿者的降温技术，在实际中暑患者中并未如此迅速地发挥作用。现有最佳证据来自使用冰水浸泡或蒸发加对流来冷却中暑患者的大型病例系列研究。
在劳力性中暑中，冰水浸泡已被证明非常有效，在年轻、健康患者的大型病例系列中死亡率为零。在老年非劳力性中暑患者中，研究更多地推广蒸发加对流降温。蒸发加对流降温可通过将碎冰或冰袋分散敷于身体来增强效果。冷静脉输液也可辅助主要的降温措施。基于目前的证据，不建议将冰袋有策略地敷于颈部、腋窝和腹股沟；使用降温毯；以及使用血管内或外部降温装置作为中暑的主要降温方法。
