【摘要】 目的总结热射病致神经系统病变的临床、神经电生理特点、影像学表现及预后。方法对2010年7、8月和2013年7、8月在本院住院的9例热射病患者的临床、神经电生理特点、影像学特点及预后进行回顾性分析。结果 9例患者中男7例、女2例,发病年龄47~87岁,均在发病6 h内就诊。所有患者入院时体温在39.8℃~42.5℃,均有意识和多脏器功能障碍,其中急性脑梗死2例,周围神经病变3例,急性呼吸衰竭2例,肺部感染9例,DIC 1例,急性心肌损害8例,心律失常3例,横纹肌溶解症3例,急性肝损害8例,急性肾损害6例,消化道出血4例,代谢性酸中毒1例,代谢性碱中毒2例,水电解质紊乱9例。行颅脑MRI扫描显示,弥漫脑回肿胀6例,新发脑梗死2例,呈非对称性点状梗死灶。给予降温、补液、抗凝、降低颅内压及对症治疗,死亡1例,好转8例。1年后随访基本痊愈2例;神经功能改善显著4例,病残程度1~2级;神经功能改善进步1例,病残程度3级;1例神经功能无变化,病残程度5级。结论热射病易导致意识障碍和多器官功能衰竭,中枢神经系统损害以弥漫性脑肿胀多见,可见脑小血管闭塞所致的梗死,也可伴有周围神经损伤,严重者会遗留持久的神经功能障碍。更多还原

【Abstract】 ObjectiveTo summarize the clinical characteristics,nerve electrophysiological features,imaging manifestations and prognosis of nervous system disorder caused by heat stroke.MethodsA retrospective study was undertaken on clinical,nerve electrophysiological and imaging characteristics and prognosis of 9 patients who had heat Stroke and received treatment during July and August in 2010 and 2013 at the Second Hospital of Shandong University.ResultsThere were seven males and two females,aged from 47 to 87 years,among 9 patients.All cases are admitted within 6 hours and their Core body temperature were 39.8℃~42.5℃.Patients had disturbance of consciousness and multiple organ dysfunction including acute cerebral infarct in 2 cases,peripheral neuropathy in 3 cases,acute respiratory failure in 2 cases,pulmonary infection in 9 cases,disseminated intravascular coagulation in 1 case,acute myocardial injury in 8 cases,arrhythmia in 3 cases,rhabdomyolysis in 3 cases,acute liver damage in 8 cases,of acute kidney injury in 6cases,upper gastrointestinal bleeding in 4 cases,metabolic acidosis in 1 case,metabolic alkalosis in 2 cases,electrolyte disorder in 9 cases and quadriplegia in 3 cases.Brain magnetic resonance imaging showed diffuse brain swelling in 6 cases and the acute asymmetric lacunar infarction in 2 cases.All patients are treated with cooling,rehydration,anticoagula-tion,reduction of the intracranial pressure and symptomatic treatment.One case died and the condition of remaining cases were improved.At one-year follow-up,the symptoms were almost cured in 2 cases,significantly improved in 4 cases with disability degree in grade 1~2,moderately improved in 1 case with disability degree in grade 3,remained unchanged in 1 case with disability degree of grade 5.ConclusionHeat stroke can cause conscious disorder and multiple organ failure.The central nervous system lesions are often presented with diffuse swelling or/and lacunar infarction and presented with peripheral nerve injury in some cases,leaving persistent neurological deficits.更多还原