Graser F
Monatsschr Kinderheilkd (1902). 1976 Jun;124(6):533-7.
In childhood hyperpyrexia is the most important factor causing the irreversibility of shock. The combination of high fever and circulatory impairment is more frequent during the first years of life. This behaviour is due to the high resistance of the arterial system in infancy. Marked general vasoconstriction increases the risk of a reduction in circulation and of heat loss, and causes hypoxia and rise of fever. The further course of shock is largely determined by microcirculatory failures. Under hyperpyrexia the disturbance of homeostasis can be intensified by shivering, blocking of perspiratio sensibilis, hyperosmolarity, brain edema, and DIC. In most cases of meningococcal sepsis shock and DIC begin with vasoconstrictive centralisation of circulation. The high-output-shock is extremely rare in children with high fever. The control of all important functions of a febril child in shock is the best baseline for the treatment. It is necessary in all shock patients in hyperpyrexia to reduce the fever and to repair the peripheral circulation. The therapy consists of antipyretic drugs, physical cooling, infusions of buffer-bases, dopamine, antibiotics and so on. In DIC heparin or streptokinase are indicated. In severe circulatory impairment combined with high fever prednisone is useful, in brain edema dexamethasone. The fatality rate of our cases has been diminished by a systematic therapy of hyperpyrexia and shock from 10 to 3 percent.
在儿童期，高热是导致休克不可逆的最重要因素。高热与循环障碍的合并情况在生命的最初几年更为常见。这种情况是由于婴儿期动脉系统的高阻力所致。明显的全身血管收缩会增加循环减少和热量散失的风险，并导致缺氧和发热加剧。休克的进一步发展在很大程度上取决于微循环衰竭。在高热情况下，体温调节稳态的紊乱会因寒战、出汗障碍、高渗状态、脑水肿和弥散性血管内凝血（DIC）而加剧。在大多数脑膜炎球菌败血症休克病例中，DIC始于循环的血管收缩性集中。高热儿童中高输出量性休克极为罕见。控制休克发热儿童的所有重要功能是治疗的最佳基础。对于所有高热休克患者，降低体温并修复外周循环是必要的。治疗包括使用退烧药、物理降温、输注缓冲碱、多巴胺、抗生素等。对于DIC，需要使用肝素或链激酶。在严重循环障碍合并高热的情况下，泼尼松有用；在脑水肿的情况下，地塞米松有用。通过对高热和休克进行系统治疗，我们病例的死亡率已从10%降至3%。
