Objective: To investigate the clinical manifestations and effects of continuous high volume hemofiltration on patients with heatstroke multi-organ dysfunction syndrome ( MODS) and to explore th? indication of continuous blood purify ( CBP) in these kind of patients. Methodology: Seven cases were diagnosed heatstroke as perspiration abundantly and coma during long-distance running or work in the weather of high temperature and humidity, they were accepted in emergency department of our hospital, the symptoms had not relieved after receiving cooling and sedative treatment, and MODS developed. Then they were changed to our department and received continuous high volume veno-venous hemofiltration ( CVVHVHF). Their clinical manifestations and effects of CVVHVHF were observed. Results:In clinical,they had coma,tachycardia,tachypnea,AKI,electrolyte disturbance,lactic acidosis,hepatic lesion and clotting time prolonged. 2 cases with rhabdomyolysis, higher myoglobin and troponin were received CVVHVHF promptly, Ultimately, they had normal renal function, normal liver function, normal blood coagulation function ana the acute kidney injure molecule declined to normal. 2 cases recovered slowly because they were received CVVHVF lately. One turned to other hospital because of psychiatric symptom. 2 cases died because of giving up treatment or receiving CVVHVF lately. Conclusion: The patients with Heatstroke and MODS can fully recover after taking a quick and correct treatment, the case who received CVVHVF lately has badly prognosis, and the case who received CVVHVF promptly could rehabilitate quickly.%目的:分析7例热射病合并多器官功能障碍综合征(MODS)患者的临床表现与救治经过,探讨此类患者行连续性血液净化治疗的时机及指征. 方法:7例患者均因高温高湿环境下行体能训练或户外工作时大量出汗、晕倒、意识不清入南京军区南京总医院治疗,物理降温后仍持续高热不退,予冬眠、镇静等治疗病情无缓解.入院后均行连续性静脉-静脉高容量血液滤过(CVVHVHF)治疗. 结果:患者入院时均处于昏睡状态,体温偏高,心率快,呼吸急促；均有急性肾损伤、严重电解质紊乱、乳酸酸中毒,合并肝功能损害和凝血时间延长.2例患者合并横纹肌溶解,血和尿肌红蛋白明显升高,血清肌钙蛋白T和肌酶显著升高,在接受CVVHVHF治疗后血、尿肌红蛋白、肌酶、肝肾功能等各项指标逐渐恢复正常.早期CVVHVHF治疗组5例,3例痊愈,1例治疗好转后转院,另1例CVVHVHF治疗24h后因家属放弃治疗死亡；晚期CVVHVHF治疗组2例,1例恢复慢(住院28d后),另1例治疗无效死亡. 结论:热射病合并MODS患者早期积极正规治疗者预后较好,CVVHVHF治疗较晚者预后较差,因此,伴多器官功能障碍的热射病患者早期行CVVHVHF治疗可加快康复.
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