总结1例6岁儿童被遗留在密闭汽车车厢内导致重症中暑的急救护理体会。针对重症中暑患儿热性窒息、体液丢失、反复高热惊厥抽搐等主要问题,采取联合降温技术,持续核心温度监测;目标导向性容量管理,维持水、电解质、酸碱平衡;人工气道管理,有效保持气道通畅;反复惊厥抽搐发作护理;家庭参与式护理。经过6 h急诊多学科的紧急救治与精准护理,患儿顺利转入急诊重症监护室继续治疗,后期转院康复治疗。1个月后随访,患儿预后良好。
Summarize the emergency care experience of severe heart stroke in a 6-year-old child who was left in a closed car carriage. To solve the major problems such as thermal asphyxia,body fluid loss,repeated febrile convulsions,we implemented combined cooling technology,continuous core temperature monitoring,target-oriented capacity management to maintain the balance of water,electrolyte and acid-base,the management of artificial airway to effectively keep the airway unobstructed,case of repeated convulsive seizures,and family participatory care. After 6 h of emergency multidisciplinary emergency treatment and precision care,the child was successfully transferred to the emergency intensive care unit for further treatment,and later transferred to the other hospital for rehabilitation treatment. After a follow-up of one month,the child had a good prognosis.
[1] 全军热射病防治专家组,热射病急诊诊断与治疗专家共识组. 热射病急诊诊断与治疗专家共识(2021版)[J]. 中华急诊医学杂志,2021,30(11):1290-1299.
Army Expert Group on Prevention and Treatment of Heat Stroke,Expert Consensus Group on Emergency Diagnosis and Treatment of Heat Stroke. Expert consensus on emergency diagnosis and treatment of heat stroke(2021 edition)[J]. Chin J Emerg Med,2021,30(11):1290-1299.
[2] Epstein Y,Yanovich R.Heatstroke[J]. N Engl J Med,2019,380(25):2449-2459.
[3] 魏婧. 应用PHS预测婴幼儿遗留在汽车内中暑致命时间的研究[D]. 上海:东华大学,2019.
Wei J.Application of PHS to predict the fatal time of heatstroke in infants left in a car[D]. Shanghai:Donghua Univ-ersity,2019.
[4] 孙灏琳,程柳,林子清. 汽车内儿童中暑死亡案例分析3例[J]. 广东公安科技,2020,28(2)64-65.
Sun HL,Cheng L,Lin ZQ.Analysis of three cases of children's heatstroke death in cars[J]. Guangdong Gongan Keji,2020,28(2):64-65.
[5] 李素娟,刘春峰,杨妮. 生理盐水和平衡盐溶液用于儿童脓毒性休克液体复苏的比较研究[J]. 实用药物与临床,2021,24(10):921-925.
Li SJ,Liu CF,Yang N.Comparative study on saline versus balanced crystalloids for fluid resuscitation in children with septic shock[J]. Pract Pharm Clin Remedies,2021,24(10):921-925.
[6] 张家赫,王丽杰. 大剂量液体复苏对儿童脓毒性休克预后影响的研究进展[J]. 中国小儿急救医学,2021,28(11):993-997.
Zhang JH,Wang LJ.Progress on the effect of high-dose fluid resuscitation on the prognosis of children with septic shock[J]. Chin Pediatr Emerg Med,2021,28(11):993-997.
[7] Alunni V,Crenesse D,Piercecchi-Marti MD,et al.Fatal heat stroke in a child entrapped in a confined space[J]. J Forensic Leg Med,2015,34:139-144.
[8] 丁亚平,夏姗姗,童祥飞,等. 2022版《AARC临床实践指南:人工气道内吸痰》解读[J]. 护理研究,2022,36(22):3953-3957.
Ding YP,Xia SS,Tong XF,et al.Interpretation of “American Association for Respiratory Care clinical practice guidelines:artificial airway suctioning”(2022 edition)[J]. Chin Nurs Res,2022,36(22):3953-3957.
[9] Schults JA,Long DA,Mitchell ML,et al.Adverse events and practice variability associated with paediatric endotracheal suction:an observational study[J]. Aust Crit Care,2020,33(4):350-357.
[10] Dexter AM,Scott JB.Airway management and ventilator-asso-ciated events[J]. Respir Care,2019,64(8):986-993.
[11] 院海燕,王景梅. 机械通气患者密闭式吸痰前预充氧必要性分析[J]. 护理学杂志,2020,35(22):5-7.
Yuan HY,Wang JM.Analysis on the necessity of giving preoxygenation to mechanically ventilated patients before closed sputum suction[J]. J Nurs Sci,2020,35(22):5-7.
[12] 王丰,林元相. 颅脑损伤后癫痫发作的研究进展[J]. 中华脑科疾病与康复杂志(电子版),2019,9(2):121-125.
Wang F,Lin YX.Research progress for posttraumatic epilepsy[J]. Chin J Brain Dis Rehabil Electron Ed,2019,9(2):121-125.
[13] Fitzgerald M,Ward J.Using standardized actors to promote family-centered care[J]. J Pediatr Nurs,2019,45:20-25.
