热射病之外的儿童中暑
- Author
- Paul Ishimine, MD
Paul Ishimine, MD
- Clinical Professor of Emergency Medicine and Pediatrics
- University of California, San Diego School of Medicine
- Section Editor
- Daniel F Danzl, MD
Daniel F Danzl, MD
- Section Editor — Environmental Emergencies
- Professor of Emergency Medicine
- University of Louisville School of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
- Translators
- 葛许华, 主治医师
葛许华, 主治医师
- 南京医科大学第二附属医院急诊科
引言
本文将总结儿童中热射病外中暑的表现、评估和治疗。儿科患者的热射病和成人患者的中暑将单独讨论 (参见“儿童热射病”和“成人重度非劳力性过热(经典热射病)”)
病理生理学
人体通过平衡热负荷与散热而将体温维持在一个狭窄的范围内。机体的热负荷来自代谢过程和从环境中吸收的热量。蒸发是炎热环境下主要的散热机制，但这一机制在相对湿度超过75%时失效。其他主要的散热方式为辐射(散发红外电磁能)、传导(直接将热量传至温度更低的邻近物体)和对流(直接将热量传至对流的气流)，但环境温度超过皮肤温度(一般为35℃/95℉)时，它们就不能有效地传递热量。
儿童应对热应激的解剖结构和生理功能都有别于成人。这些区别可能增加了儿童发生严重中暑的风险，尤其是婴儿和年轻运动员[1,2]。儿童中暑的病理生理学将会单独详细讨论。 (参见“儿童热射病”，关于‘病理生理学’一节)
评估和治疗
所有热相关疾病都是源于过度热暴露，其原因为环境温度增加、机体无法散发内生热量或这两者的共同作用。热相关疾病有众多表现(表 1)。
痱子(热疹) — 痱子是新生儿中的常见表现，温暖气候下尤其如此。其也可见于年龄较大的人群。外泌汗腺汗管在角质层水平被角蛋白阻塞可导致汗液在导管下段积聚。患者常发生瘙痒。痱子引起的几种皮损如下(参见“新生儿与小婴儿的良性皮肤和头皮病变”，关于‘痱子’一节)：
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