Article(id=1199334726340276263, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1199334721185477563, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.1643.2024.0122, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1702396800000, receivedDateStr=2023-12-13, revisedDate=null, revisedDateStr=null, acceptedDate=1704643200000, acceptedDateStr=2024-01-08, onlineDate=1763873281321, onlineDateStr=2025-11-23, pubDate=1714233600000, pubDateStr=2024-04-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1763873281321, onlineIssueDateStr=2025-11-23, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1763873281321, creator=13701087609, updateTime=1763873281321, updator=13701087609, issue=Issue{id=1199334721185477563, tenantId=1146029695717560320, journalId=1189873630562394117, year='2024', volume='49', issue='4', pageStart='367', pageEnd='488', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1763873280092, creator=13701087609, updateTime=1763874025072, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1199337845925183534, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1199334721185477563, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1199337845925183535, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1199334721185477563, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=367, endPage=370, ext={EN=ArticleExt(id=1199334726642266163, articleId=1199334726340276263, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Reconstructing technology program for heat endurance of soldiers with exertional heat illness (first edition), columnId=1190310109461971339, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Guideline and Consensus, runingTitle=null, highlight=null, articleAbstract=

Officers and soldiers exposed to high temperature and high-humidity environments are highly susceptible to exertional heat illness and even heatstroke. Reports indicated that after conventional treatment, the heat endurance damage in officers/soldiers with exertional heat illness can persist for months or even years. Therefore, the Expert Group of Heatstroke Prevention and Treatment of Heatstroke of Chinese PLA has specially formulated a technical proposal for the reconstruction of heat endurance in officers/soldiers suffering from exertional heatstroke, aiming to provide a safeguard for reconstruction of heat endurance in affected personnel. This article mainly elaborates on the basic concepts, technical requirements, initiation timing, implementation assessment, and follow-up of the heat endurance reconstruction for officers/soldiers with exertional heatstroke.

, correspAuthors=Qing Song, Bo Ning, authorNote=null, correspAuthorsNote=
Song Qing, E-mail:
Ning Bo, E-mail:
, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, authorCompany=null, fund=null, authors=null, authorsList=Jing-Chun Song, Qing Song, Bo Ning, Hai-Ling Li, Yan Gao, Expert Group of Heatstroke Prevention and Treatment of Chinese PLA), CN=ArticleExt(id=1199334727812477006, articleId=1199334726340276263, tenantId=1146029695717560320, journalId=1189873630562394117, language=CN, title=劳力性中暑官兵热耐力重建技术方案(1), columnId=1190310109688463760, journalTitle=解放军医学杂志, columnName=指南与共识, runingTitle=null, highlight=null, articleAbstract=

官兵在高温高湿环境下进行训练极易发生劳力性中暑甚至热射病。劳力性中暑患病官兵在完成常规治疗后,其热耐力损伤可持续存在数月甚至数年。因此,全军热射病防治专家组特制定劳力性中暑官兵热耐力重建技术方案,以期为发生劳力性中暑的官兵在医院进行热耐力重建提供保障。本文主要阐述劳力性中暑官兵热耐力重建的基本概念、技术要求、启动时机、实施评估及随访方案等。

, correspAuthors=宋青, 宁波, authorNote=null, correspAuthorsNote=
宋青,E-mail:
宁波,E-mail:
, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=ezy1oVhx0eeSxHbMQZzLqg==, magXml=3fDg04pugcGak2f4R35+ow==, pdfUrl=null, pdf=5tTqbt+oe/AQyiGH/hi/rQ==, pdfFileSize=938634, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=+QoWtWst2celT1vK3wjrCg==, mapNumber=null, authorCompany=null, fund=null, authors=

宋景春,医学博士,主任医师,主要从事热射病防治的基础与临床工作

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宋景春,医学博士,主任医师,主要从事热射病防治的基础与临床工作

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宋景春,医学博士,主任医师,主要从事热射病防治的基础与临床工作

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劳力性中暑官兵热耐力重建技术方案(1)
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宋景春 1, 2 , 宋青 2, 3, * , 宁波 2, 4, * , 李海玲 2, 5 , 高燕 2, 6 , 全军热射病防治专家组
解放军医学杂志 | 指南与共识 2024,49(4): 367-370
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解放军医学杂志 | 指南与共识 2024, 49(4): 367-370
劳力性中暑官兵热耐力重建技术方案(1)
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宋景春1, 2, 宋青2, 3, * , 宁波2, 4, * , 李海玲2, 5, 高燕2, 6, 全军热射病防治专家组
作者信息
  • 1联勤保障部队第908医院重症医学科,江西南昌 330002
  • 2全军热射病防治与研究中心 海南三亚 572013
  • 3解放军总医院海南医院重症医学科,海南三亚 572013
  • 4空军特色医学中心重症医学科,北京 100142
  • 5海军第971医院重症医学科,山东青岛 266071
  • 6北部战区总医院急诊科,辽宁沈阳 110016
  • 宋景春,医学博士,主任医师,主要从事热射病防治的基础与临床工作

通讯作者:

宋青,E-mail:
宁波,E-mail:
Reconstructing technology program for heat endurance of soldiers with exertional heat illness (first edition)
Jing-Chun Song1, 2, Qing Song2, 3, * , Bo Ning2, 4, * , Hai-Ling Li2, 5, Yan Gao2, 6, Expert Group of Heatstroke Prevention and Treatment of Chinese PLA
Affiliations
  • 1Department of Critical Care Medicine, the 908th Hospital of Joint Logistics Support Force of Chinese PLA, Nanchang, Jiangxi 330002, China
  • 2Chinese PLA Heatstroke Prevention and Treatment Research Center, Sanya, Hainan 572013, China
  • 3Department of Critical Care Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan 572013, China
  • 4Department of Critical Care Medicine, Air Force Characteristic Medical Center, Beijing 100142, China
  • 5Department of Critical Care Medicine, Navy 971th Hospital of Chinese PLA, Qingdao, Shandong 266071, China
  • 6Department of Emergency, Northern Theater General Hospital, Shenyang, Liaoning 110016, China
出版时间: 2024-04-28 doi: 10.11855/j.issn.0577-7402.1643.2024.0122
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官兵在高温高湿环境下进行训练极易发生劳力性中暑甚至热射病。劳力性中暑患病官兵在完成常规治疗后,其热耐力损伤可持续存在数月甚至数年。因此,全军热射病防治专家组特制定劳力性中暑官兵热耐力重建技术方案,以期为发生劳力性中暑的官兵在医院进行热耐力重建提供保障。本文主要阐述劳力性中暑官兵热耐力重建的基本概念、技术要求、启动时机、实施评估及随访方案等。

劳力性中暑  /  热耐力  /  军事医学  /  重建

Officers and soldiers exposed to high temperature and high-humidity environments are highly susceptible to exertional heat illness and even heatstroke. Reports indicated that after conventional treatment, the heat endurance damage in officers/soldiers with exertional heat illness can persist for months or even years. Therefore, the Expert Group of Heatstroke Prevention and Treatment of Heatstroke of Chinese PLA has specially formulated a technical proposal for the reconstruction of heat endurance in officers/soldiers suffering from exertional heatstroke, aiming to provide a safeguard for reconstruction of heat endurance in affected personnel. This article mainly elaborates on the basic concepts, technical requirements, initiation timing, implementation assessment, and follow-up of the heat endurance reconstruction for officers/soldiers with exertional heatstroke.

exertional heat illness/exertional heatstroke  /  heat endurance  /  military medicine  /  reconstruction
宋景春, 宋青, 宁波, 李海玲, 高燕, 全军热射病防治专家组. 劳力性中暑官兵热耐力重建技术方案(1). 解放军医学杂志, 2024 , 49 (4) : 367 -370 . DOI: 10.11855/j.issn.0577-7402.1643.2024.0122
Jing-Chun Song, Qing Song, Bo Ning, Hai-Ling Li, Yan Gao, Expert Group of Heatstroke Prevention and Treatment of Chinese PLA. Reconstructing technology program for heat endurance of soldiers with exertional heat illness (first edition)[J]. Medical Journal of Chinese People’s Liberation Army, 2024 , 49 (4) : 367 -370 . DOI: 10.11855/j.issn.0577-7402.1643.2024.0122
中暑是因人体致热因素导致产热散热功能障碍而发生的疾病[1]。热射病是机体长时间暴露在高温、高湿环境下而出现的产热与散热失衡,以体温调节障碍、水电解质过量丢失,以及神经系统功能损害为主要临床特征,是可致死性中暑[2]。我国热带、亚热带区域广,高温高湿持续时间长,军队在高温高湿环境中长时间训练或从寒区转到热区训练时,易发生热射病[3]。在“十早一禁”的救治原则指导下,劳力性中暑官兵的生理和生化指标可逐步恢复正常,但其热耐力往往还没有恢复[4-5]。此时让劳力性中暑官兵归队后进行正常的训练工作,可能会导致再次中暑[6]。因此,全军热射病防治专家组特制定《劳力性中暑官兵热耐力重建技术方案》,为劳力性中暑官兵进行热耐力重建提供技术保障。
热耐力是从温暖到炎热条件下保持身体活动的能力,是机体心血管功能、神经生物学功能及全身细胞反应能力的综合反映。与适宜环境相比,人体在热环境(≥25 ℃)下运动时其热耐力会受到损伤[7],其机制为:(1)运动时肌肉产热增加,机体通过增加皮肤血流量和出汗量来增加散热,从而加重机体的生理负荷和心血管压力;(2)血液过多分流到皮肤使骨骼肌血流量减少,从而导致组织氧输送和营养物质供给不足,肌肉中的代谢废物清除率下降;(3)运动过程中出汗导致脱水,进一步损害心排血量和散热能力。热耐力损伤与个体运动适应能力、既往损伤和遗传因素有关。劳力性热射病患者的热耐力损伤可以是暂时的,也可以持续数年[8]
当环境温度或湿度升高时,人体可通过产热散热中枢来调节热代谢活动,形成热适应[9]。人体通过反复暴露在热应激下的方式来提高自身热耐受能力的过程称为热习服[10],其具体机制与改善体温调节能力、骨骼肌代谢、心血管稳定性和全身耐热性有关[11-12]
热耐力重建治疗团队需包括急诊或重症医学科、康复理疗科、心理科、中医科等专业医师及护理人员。
热耐力重建需配备准备室、热耐力训练室、监控室和休息室。准备室主要用于热耐力测试或训练前的准备。热耐力训练室主要用于官兵的热耐力测试和训练。监控室用于监测和分析官兵进行热耐力测试或训练时的生理数据。休息室用于热耐力测试或训练后的恢复。
热耐力监测室是采用人工热室模拟高温高湿环境,热室内部尺寸为4 m×3 m×3 m,加热功能、加湿功能、除湿功能、温湿度检测分别由2台2500 W油汀、1台功率>200 W加湿器、1台2匹具有除湿功能的空调以及1台三球温度计来实现[13]。训练时室温控制在40 ℃,偏差为±0.2 ℃,室内相对湿度控制在40%,偏差为±5%。热室内设1台跑步机,置于热室中部位置,可调节速度和坡度,用来模拟训练强度。热耐力训练室需配备生命体征监测设备,主要包括监测核心体温的电子肛温计或耳温仪,监测心率的心电监护仪或可穿戴式监测设备。
在劳力性中暑伤员接受初始治疗结束7 d内应避免过度运动[14]。开始热耐力重建之前,应首先对伤员的热耐力状况进行生理、心理和热耐力评估。
生理评估内容包括伤员的基础生命体征、血常规、生化、凝血项目和针对心、脑、肺、肝、肾等实质器官的影像学检查。一项针对2529例劳力性热射病(exertional heat stroke,EHS)事件的回顾性分析表明,急性肾损伤(血尿素氮、肌酐、尿常规)指标通常在发病当天达到峰值,并在24~48 h恢复正常;肌肉和肝功能损伤相关标志物通常在发病后4 d内达到峰值,并持续升高2~16 d[15]。生理评估内容应在热习服训练前均恢复至正常范围。
劳力性中暑伤员可能会有心理应激,从而影响热耐力重建效果,甚至产生害怕训练、失去信心的心理状态,严重的甚至会引发应激障碍。因此,在进行热耐力重建前可使用劳力性中暑伤员心理评估量表(附表https://dx.doi.org/10.11855/j.issn.0577-7402.1643.2024.0122FJ)进行心理评估。
此量表包括焦虑、抑郁、睡眠、应激等4个维度,并根据4级评分法评定相关症状的出现频率。每个问题的答案可根据受试者的回答进行赋分:1分,没有或很少时间;2分,小部分时间;3分,相当多时间;4分,绝大部分或全部时间。此量表包括30个问题,将30个问题分值相加得出总分(满分为120分),心理应激指数根据公式(总分÷120×100%)计算。结果显示,该指数<50%者为心理正常;50%~60%者为轻度心理障碍;60%~70%者为中度心理障碍;≥70%者为重度心理障碍。
结果评定异常者需经心理科医师确定评定结果。确定评价结果后,轻、中度心理障碍可采用积极资源取向等方法进行心理干预,中、重度心理障碍可接受稳定化技术、系统脱敏等心理治疗,必要时结合药物治疗。心理障碍者需经治疗待心理障碍完全缓解后再进行热耐力评估。
热耐力测试是评价热耐力的客观方法,适用于需要进行热耐力测试的平时训练人员和劳力性中暑后的恢复期伤员[16]。劳力性中暑后恢复期伤员在进行热耐力重建前应进行热耐力测试,特别是反复发生劳力性中暑的伤员。
受试者在测试前需保证三餐规律饮食,睡眠充足,避免重体力劳动、饮酒及食用辛辣刺激食物。进入人工热室前需在温度26 ℃、相对湿度50%的良好环境中静坐20 min。经询问受试者身体状况无任何不适的情况下,进入已设定好温度40 ℃、相对湿度40%的人工热室内进行热耐力测试。跑步机坡度设置为2°,跑步速度设置为5 km/h。热耐力测试时长以跑步机上跑步2 h为上限。测试过程中采用电子肛温计(或耳温计)实时监测直肠(耳鼓膜)温度和脉率,至少每5 min记录1次[17]
测试过程中出现以下三项中的任意一项,即停止测试:(1)脉率>150次/min;(2)直肠(耳鼓膜)温度>38.5 ℃;(3) 受试者自感不适并主动要求停止[18]。热耐力测试过程中提供2 L液体(1.5 L矿泉水+0.5 L口服补液盐)进行补充,并且在测试期间配备2名医护人员进行安全保障。
热耐力测试前后均需测量直肠(耳鼓膜)温度、脉率、血压、体重,计算体重指数(BMI),并记录运动时间、运动距离。
测试结束后计算生理应激指数(physiological stress index,PSI)[19]。PSI计算方法:PSI39.5/180=5(TCt-TC0)/(39.5-TC0)+5(HRt-HR0)/(180-HR0),其中39.5为最大耐受温度,180为极量最大脉率;TC0和HR0为测试前的直肠(耳鼓膜)温度及脉率,TCt和HRt为测试中的最高直肠(耳鼓膜)温度及最快脉率。
完成热耐力测试后,医护人员应出具热耐力评估报告。PSI是机体热应激的量化指标,可用来衡量机体热耐受性,生理应激指数≥5提示热耐力不良,生理应激指数<5提示热耐力合格,生理应激指数<4提示热耐力良好[17,20]
经过热耐力测试评定热耐力不良者需进行热耐力重建。医师应根据伤员的生理、心理状态和热耐力测试结果制定个体化的热耐力重建计划。热耐力评定合格者,也可通过热耐力训练提高热耐力。
热耐力训练要求与热耐力测试类似。训练过程中如受训人员生理指标稳定,可根据训练人员意愿和状态适当延长训练时长。训练效果评价仍以PSI为主。在训练过程中,直肠(或耳鼓膜)温度上升速度、脉率上升速度等也可作为热耐力的监测指标,但具体标准尚未明确统一[21]
热室中训练周期以7~10 d为宜,具体时长可根据受训人员的热损伤严重程度和热耐力恢复情况调整。恢复效果不理想者可延长至14 d[22]
完成热耐力训练周期后,医护人员应出具热耐力重建效果评估报告。通过每日训练效果的连续比较来评价热耐力重建的效果。热耐力重建目标以PSI<4.5为基本目标,<4可视为效果满意。热应变评分指数、主观体力感觉等级和热感觉问卷等心理指标也被报道用于评价热习服效果[23]
热耐力重建过程中需要保证安全。训练时机体随着训练负荷增加会发生相应改变。高强度训练会导致训练人员的核心温度升高,存在诱发中暑的风险。同时受训者体液大量丢失可导致血液浓缩,凝血酶生成增加,血小板计数升高,纤溶功能抑制,整体呈现高凝状态。因此,热耐力训练过程中应注意给训练人员及时补水补盐[24]。此外,治疗过程中需至少有两名医护人员监测生命体征的变化情况,当脉率>150次/min、直肠(耳鼓膜)温度>38.5 ℃或受训者明显不适时停止训练。已有研究显示,热耐力训练推荐的常规热室内训练方案对受训人员的凝血指标、肝肾功能、肌酸激酶、血栓弹力图和凝血分子标志物均无明显影响[25]
热耐力评价合格者,可归队参加正常训练和工作。医护人员应在劳力性中暑患者出院后2周时进行电话随访。如有不适应正常训练者可根据具体训练情况给出指导意见,必要时可重新测试热耐力。
编写组成员(按拼音排序):边革元(联勤保障部队第920医院重症医学科);陈威(解放军总医院第三医学中心急诊科);崔岩(北部战区总医院重症医学科);崔云亮(联勤保障部队第960医院重症医学科);高燕(北部战区总医院急诊科);何蕾(解放军总医院第一医学中心肝胆胰外科重症监护病房);李福祥(西部战区总医院重症医学科);李海玲(海军971医院重症医学科);李庆华(联勤保障部队第990医院重症医学科);李奕鑫(联勤保障部队第910医院急诊科);刘东(联勤保障部队第940医院重症医学科);刘树元(解放军总医院第六医学中心急诊科);宁波(空军特色医学中心重症医学科);宋景春(联勤保障部队第908医院重症医学科);宋青(解放军总医院海南医院重症医学科);宋薇薇(联勤保障部队第908医院心理科);孙海龙(解放军疾病预防控制中心);唐忠志(中部战区总医院急诊科);童智慧(东部战区总医院重症医学科);汪茜(解放军总医院第三医学中心急诊科);文强(南部战区总医院重症医学科);张伟(联勤保障部队第900医院急诊科);张西京(空军军医大学附属西京医院重症医学科);张玉景(陆军第71集团军医院重症医学科);张玉想(解放军总医院第八医学中心重症医学科);赵贵锋(火箭军特色医学中心重症医学科);周新(陆军乌鲁木齐总医院重症医学科)
  • 2023年度军队卫生防疫专项任务(20230033)
  • 军队基础加强计划重点基础研究项目(2022-JCJQ-ZD-097-11)
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2024年第49卷第4期
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doi: 10.11855/j.issn.0577-7402.1643.2024.0122
  • 接收时间:2023-12-13
  • 首发时间:2025-11-23
  • 出版时间:2024-04-28
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  • 收稿日期:2023-12-13
  • 录用日期:2024-01-08
基金
2023 Military Health and Epidemic Prevention Special Task(20230033)
2023年度军队卫生防疫专项任务(20230033)
Key Research Project of the Military Basic Strengthening Program(2022-JCJQ-ZD-097-11)
军队基础加强计划重点基础研究项目(2022-JCJQ-ZD-097-11)
作者信息
    1联勤保障部队第908医院重症医学科,江西南昌 330002
    2全军热射病防治与研究中心 海南三亚 572013
    3解放军总医院海南医院重症医学科,海南三亚 572013
    4空军特色医学中心重症医学科,北京 100142
    5海军第971医院重症医学科,山东青岛 266071
    6北部战区总医院急诊科,辽宁沈阳 110016

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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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