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1 Med J Chin PLA, Vol. 44, No. 3, March 28, [ ] [ ] [ ] R594.1 [ ] A [ ] (2019) [DOI] /j.issn (heat stroke HS) [1-2] [3-4] 2015 ( ) [5] / 40 (classic heat stroke CHS) (exertional heat stroke EHS) CHS CHS EHS EHS EHS [6-8] [ ] [ ] songqing @sina.com ningboicu@163.com

2 CHS (17.6~26.5)/10 14%~65% ICU 60% [9-14] EHS 8.6%~18% 30% [13-16] ( ) CHS 39 [17-18] [19-22] CHS ( ) EHS [23-24] EHS EHS [25-26] ( ) EHS CHS ( ) 1~2d 40~ EHS ( ) 40 [27] [28] [29] (disseminated intravascular coagulation DIC) 45% [29] (thrombomodulin TM) / -1 (tissue plasminogen activator-inhibitor complex t-paic) - (thrombin-antithrombin complex TAT) - 2 ( 2 -plasmin inhibitor-plasmin complex PIC) TM t-paic TAT PIC DIC (platelet PLT) (fibrinogen Fib) (fibrinogen degradation product FDP) D- (D-Dimer DD) (prothrombin time PT) (activated partial thromboplastin time APTT) (antithrombin AT) (D-D PLT Fib PT APTT) 1~3d DIC (thrombelastography TEG)

3 Med J Chin PLA, Vol. 44, No. 3, March 28, TEG R K MA R K MA LY30%>8% CI<-3 (activated clotting time ACT) (clot rate CR) (platelet function PF) ACT CR PF EHS [30] (aspartate aminotransferase AST) (alanine aminotransferase ALT) (lactate dehydrogenase LDH) 3~4d ( 2 ) AST 9000U/L ALT LDH U/L 24~72h [5,29] DIC ( ) 25%~35% EHS 5% CHS [31] % 10% (acute respiratory distress syndrome ARDS) [29] ( ) DIC [32-33] 72h [34-35] [36-37] (CK) (CK-MB) I (ctni) (CI) (SVR) CI SVR [38-39] [31] 24h CK 5~7d 40 U/L (Mb) >1000ng/ml ~80 000ng/ml [5] CHS EHS EHS DIC CHS 4 TEG ( ) 1

4 Tab.1 Laboratory indicators and frequency recommended for monitoring in patients with heat stroke WBC Neut% PLT Hb HCT 1~2 /d ctni CK-MB BNP 1~2 /d CK Mb 1 /d PT APTT D-Dimer Fib PT% 1 /4h Cr Urea 1 /d AST ALT LDH TBil 2 /d CRP PCT IL-6 1 /d K + Na + Cl Ca 2+ 1~2 /d BG 1 /2h ph PO 2 PCO 2 HCO 3 BE Lac 1 /4h 5 X CT MRI h ( ) ( ) QT ST [40-41] 5.2 ( ) [42] 5.3 CT CT CT 2~5d CT [43] 7~10d [44] 5.4 MRI [43-46] MRI T 1 T 2 DWI FLAIR MRI MRI MRI MRI MRI [47] 5.5 [48-50] [9,51-54] ( ) 40 ( 2 ) ( ) DIC (

5 Med J Chin PLA, Vol. 44, No. 3, March 28, ) 40 ( ) ( ) ( ) ( ) ( ) EHS CHS ( ) 16~ cm [55] ( ) ( ) 10min 7.3 [56] 30min 30min 40.0 [23,57] 30min h 38.5

6 ~38.5 [6,58] ( ) [59-69] 15~ ~33 ( ) 30~33 CHS EHS EHS ( ) (2~20 ) 0.13~0.19 /min ( 26 ) 9~10min ( ) 30min /min 4~10 (1min 10ml/kg 1min ) ( 6cm 15~20ml/min 200~500ml 1~2min ) 4 EHS 60min 25ml/kg 1000~1500ml ( ) 1 30ml/kg 1500~2000ml( ) ( ) 100~200ml/h [70] 7.5 [71-72] / (SpO 2 ) SpO 2 90% [51] ~20mg 2~3min 20min 10mg 24h 50mg 5~8mg/kg 8 8.1

7 Med J Chin PLA, Vol. 44, No. 3, March 28, ( )30min ~1.0h 1 4~10 ( ) (targeted temperature management TTM) [73] [74] TTM TTM ( ) 15cm 10min [55,58] ( ) [51,75-76] ( ) (continuous blood purification CBP) / - (CVVHDF) / [58] [59] 38.6~ [6,8,59,77] 37.0~ [78] CHS EHS [79-81] 9.2

8 SpO 2 90%~99% (PaO 2 ) 60~100mmHg PaCO 2 35~45cmH 2 O [51] ( ) / / [71-72] 30cmH 2 O PEEP 9.3 [82-85] SpO 2 (CVP) ( ScvO 2 Pv-aCO 2 ) PiCCO ( ) ( ) CVP ScvO 2 Pv-aCO 2 [86] MAP 65mmHg 200mg/d TEG [54,87] (1) PT APTT 1.5 TEG R>10min ACT>160s( ) >240s( ) 15~30ml/kg [88] Fib 1.5g/L TEG FFMA<10mm CR<10 (10ml/kg) Fib(30~50mg/kg) Fib 1.5g/L [89] (2) < /L TEG MA<50mm FFMA>10mm PF<1 1 1 (10~20) 10 9 /L 1h [90] (3) (r ) r >24% > /L Fib>1.5g/L r 200 g/kg 2h 100 g/kg [91] DIC

9 Med J Chin PLA, Vol. 44, No. 3, March 28, TEG - (TAT) D- (DD) (FDP) - 2 (PIC) ( ) [92] [93-95] (UFH) UFH UFH UFH 1~8U/(kg.h) APTT TEG R ACT TEG R/Rh 1.5~2.0 UFH (HIT) UFH > 50% ( ) 4T HIT HIT HIT UFH 1mg/kg 2 /d Xa 0.6~1.0U/ml HIT (TT) 0.2~0.5 g/(kg.min) APTT TEG R ACT ( 25~30min) HIT HIT 0.05mg/(kg.h) APTT TEG R ACT rat rtm rat rtm DIC PLT TAT DD FDP PIC %~30% [96] [46,97-100] [51, ] 125ml 2~3 /d 7~10d CRRT

10 [106] DIC [107] 5% [ ] ( ) [30,108] B CT AST ALT LDH 3~4d 24~72h DIC [110] (PDF) PDF CRRT( CVVHDF) EHS [111] 9.7 ( ) EHS (72h ) 72h ( / ) ( ) [112] ( ) 30~45 37~40 20ml/h 20~25kcal/(kg.d) ( ) [ ] 9.8 (rhabdomyolysis RM) EHS ( ) (multiple organ dysfunction syndrome MODS) [114] RM CK U/L CK RM [115] 48h CK [116] 1~3h 150ng/ml RM RM ( )

11 Med J Chin PLA, Vol. 44, No. 3, March 28, (1) RM RM 0.45% (5% 1:1 ) 500ml/h ( ) 200~300ml/h 5%NaHCO 3 ph 6.5 ph 7.5 [117] (2) RM [118] (3)CBP 17.6kD 20nm / [119] (CVVH) (CVVHDF) (CVVHD) [120] 9.9 CBP CBP CBP [ ] ( CRRT MR ) CBP CBP CBP 40 2h 6.5mmol/L CK 5000U/L 1 /12h AKI SCr 44.2 mol/l CRRT CK 1000U/L 1500ml/d 10 ( ) CHS EHS (heat adaptation) (heat acclimatization) 10.1 CHS ( ) ( ) ( \ \ ) 30 CHS ( ) ( ) [124] 10.2 EHS [ ] /

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