背景:尽管经典的中暑(HS)是人类已知的最古老的条件之一,对其早期临床表现的描述,自然课程,并发症仍然不确定。
目标:对人口统计学的系统评价,临床特征,生物标志物,治疗,以及在麦加沙漠气候下穆斯林朝圣期间HS的结果,沙特阿拉伯。
方法:我们搜索了MEDLINE,Embase,WebofScience核心合集,Scopus,和CINAHL数据库从成立到2022年4月。我们总结了来自符合条件的研究的数据,并使用汇总的描述性统计数据以叙述形式对其进行了综合。
结果:44项研究,包括2632名HS患者,符合纳入标准。超重或肥胖,糖尿病,和心血管疾病在HS病例中普遍存在。证据表明,极端高热(合并平均值=42.0°C[95%置信区间(CI):41.9,42.1],范围40-44.8°C)皮肤干燥(>99%的病例)和严重的意识丧失(53.8%的病例中平均格拉斯哥昏迷评分<8)是经典HS的主要临床特征。低血压,呼吸急促,呕吐,腹泻,和生化生物标志物表明轻度至中度横纹肌溶解症,急性肾,肝脏,心脏损伤,发病时凝血病频繁。同时,应激激素(皮质醇和儿茶酚胺)和系统性炎症和凝血激活的生物标志物增加。18例中有1例HS致死(合并病死率=5.6%[95CI:4.6,6.5])。
结论:这篇综述的结果表明,HS诱导了早期多器官损伤,可迅速发展为器官衰竭,最终导致死亡,如果不及时识别和治疗。
Although classic heat stroke (HS) is one of the most ancient conditions known to humans, the description of its early clinical manifestations, natural course, and complications remains uncertain.
A systematic
review of the demographics, clinical characteristics, biomarkers, therapy, and outcomes of HS during the Muslim (Hajj) pilgrimage in the desert climate of Mecca, Saudi Arabia.
We searched the MEDLINE, Embase, Web of Science Core Collection, SCOPUS, and CINAHL databases from inception to April 2022. We summarized the data from eligible studies and synthesized them in narrative form using pooled descriptive statistics.
Forty-four studies, including 2632 patients with HS, met the inclusion criteria. Overweight or obesity, diabetes, and cardiovascular disease were prevalent among cases of HS. Evidence suggests that extreme hyperthermia (pooled mean = 42.0°C [95% confidence interval (CI): 41.9, 42.1], range 40-44.8°C) with hot and dry skin (>99% of cases) and severe loss of consciousness (mean Glasgow Coma Scale <8 in 53.8% of cases) were the dominant clinical characteristics of classic HS. Hypotension, tachypnea, vomiting, diarrhea, and biochemical biomarkers indicating mild-to-moderate rhabdomyolysis, acute kidney, liver, heart injury, and coagulopathy were frequent at the onset. Concomitantly, stress hormones (cortisol and catecholamines) and biomarkers of systemic inflammation and coagulation activation were increased. HS was fatal in 1 in 18 cases (pooled case fatality rate = 5.6% [95%CI: 4.6, 6.5]).
The findings of this
review suggest that HS induces an early multiorgan injury that can progress rapidly to organ failure, culminating in death, if it is not recognized and treated promptly.