目的 分析部队医院重症中暑住院病人的发病原因、类型、合并重要脏器功能损害以及死亡情况。方法 回顾性统计8所部队医院1988年1月～2005年3月共117例中暑住院病人的临床资料。结果 117例中暑病人中有110例（94．02％）发生在军事训练中，其中11例（10％）训练前或训练中合并有轻微不适；重症中暑中热射病、热痉挛、热衰竭的发生率分别为43．62％、42．55％、13．83％，三者的死亡率分别为9．76％、5％、23％；重症中暑合并肝功能损害者占31．9％，合并中枢神经功能损害者占14．9％，合并多器官功能衰竭（MOF）者占21．3％；不合并重要脏器功能损害的病人全部存活，合并单个重要脏器功能损害者死亡率为3．6％，合并MOF者死亡率为35％。结论 尝试建立中暑军事化预报指数对科学指导基层部队训练可能有益；中暑救治过程中除了降低中心体温这一“第一关键点”外，对于合并多个重要脏器功能损害、死亡率高的病人治疗上可能还存在“第二关键点”；当前部队中暑医疗救助体系还需要进一步完善。
Objective To investigate and analyze the cause of the illness, types and conditions combined with dysfunction of important organs and death of severe heatstroke patients in military hospitals in southern China. Methods 117 cases of heatstroke patients from Jan 1988 to Mar 2005 admitted to 8 military hospitals were retrospectively analyzed. Results 94.02% of the cases occurred during military drill; 10% of patients complained of slight discomfort before or during the drill; the incidence of thermoplegia, heat cramp and heat exhaustion were 43. 26%, 42. 55% and 13.86%, respectively, in severe heatstroke, and the respective death rate was 9. 76%, 5% and 23%. The incidence of severe heatstroke combined with liver dysfunction was 31.9%, with central nervous impairment was 14. 9%, and with MOF was 21.3%. All patients survived when no organ dysfunction occurred; the death rate in those with single organ dysfunction was 3. 6 %, while it was 35 % in MOF patients. Conclusion An attempt to set up a predicting index of heatstroke might be beneficial for scientifically supervising the military drill for the servicemerL Reduction of the core temperature is the＂the first critical point＂in the treatment. Other ＂critical point＂ in the treatment may also be emphasized for those with MOF. The present therapeutic system for heat stroke as executed in the military needs to be perfected.
Medical Journal of Chinese People's Liberation Army