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体温过高和[[发燒]]不同，前者的体温调定点自始至终保持不变。和体温过高相对的是[[失溫症]]，指的是体温低于日常新陈代谢所需的温度的情况。
体温过高和[[发燒]]不同，前者的体温调定点自始至终保持不变。和体温过高相对的是[[失溫症]]，指的是体温低于日常新陈代谢所需的温度的情况。


==分類==

{{HumanTemperature}}
{{trans H}}
In humans, hyperthermia is defined as a temperature greater than {{convert|37.5|–|38.3|C|F}}, depending on the reference used, that occurs without a change in the body's [[體溫調節|temperature set point]].<ref name=NC08/><ref name=CC09/>

The [[人體溫度|normal human body temperature]] can be as high as {{convert|37.7|C|F}} in the late afternoon.<ref name=Harrisons/> Hyperthermia requires an elevation from the temperature that would otherwise be expected. Such elevations range from mild to extreme; body temperatures above {{convert|40|C|F}} can be life-threatening.

==Signs and symptoms==
An early stage of hyperthermia can be "heat exhaustion" (or "heat prostration" or "heat stress"), whose symptoms include heavy sweating, rapid breathing and a fast, weak pulse. If the condition progresses to heat stroke, then hot, dry skin is typical<ref name=Harrisons/> as [[血管|blood vessel]]s dilate in an attempt to increase heat loss. An inability to cool the body through [[汗液|perspiration]] may cause the skin to feel dry.

Other signs and symptoms vary. Accompanying dehydration can produce [[恶心|nausea]], vomiting, [[頭痛|headaches]], and [[低血壓|low blood pressure]] and the latter can lead to [[昏厥|fainting]] or [[頭暈|dizziness]], especially if the standing position is assumed quickly.

In severe heat stroke, there may be confused, hostile, or seemingly intoxicated behavior. Heart rate and respiration rate will increase ([[心跳过速|tachycardia]] and {{tsl|en|tachypnea||tachypnea}}) as blood pressure drops and the heart attempts to maintain adequate [[循环系统|circulation]]. The decrease in blood pressure can then cause blood vessels to contract reflexively, resulting in a pale or bluish skin color in advanced cases. Young children, in particular, may have [[癲癇發作|seizures]]. Eventually, {{tsl|en|organ failure||organ failure}}, {{tsl|en|unconsciousness||unconsciousness}} and [[死亡|death]] will result.

==Causes==

[[中暑|Heat stroke]] occurs when thermoregulation is overwhelmed by a combination of excessive metabolic production of heat (exertion), excessive environmental heat, and insufficient or impaired heat loss, resulting in an abnormally high body temperature.<ref name=Harrisons /> In severe cases, temperatures can exceed {{convert|40|C|F}}.<ref name=EMS>{{cite book |title=Emergency Medicine: A Comprehensive Study Guide, Sixth edition |last=Tintinalli |first=Judith |year=2004 |publisher=McGraw-Hill Professional |location= |isbn=0-07-138875-3 |page=1187 |url= }}</ref> Heat stroke may be ''non-exertional'' (classic) or ''exertional''.

===Exertional===
Significant physical exertion in hot conditions can generate heat beyond the ability to cool, because, in addition to the heat, humidity of the environment may reduce the efficiency of the body's normal cooling mechanisms.<ref name=Harrisons>{{cite book
| authorlink = Anthony Fauci
| author = Fauci, Anthony| title = {{tsl|en|Harrison's Principles of Internal Medicine||Harrison's Principles of Internal Medicine}}
| edition = 17th
| publisher = McGraw-Hill Professional
| year = 2008
| isbn = 978-0-07-146633-2
| pages = 117–121
|display-authors=etal}}</ref> Human heat-loss mechanisms are limited primarily to sweating (which dissipates heat by [[蒸发|evaporation]], assuming sufficiently low [[湿度|humidity]]) and [[血管舒張|vasodilation]] of skin vessels (which dissipates heat by [[對流|convection]] proportional to the [[温度|temperature]] difference between the body and its surroundings, according to [[冷却定律|Newton's law of cooling]]). Other factors, such as insufficient water intake, consuming alcohol, or lack of [[空氣調節|air conditioning]], can worsen the problem.

The increase in body temperature that results from a breakdown in thermoregulation affects the body biochemically. [[酶|Enzyme]]s involved in metabolic pathways within the body such as cellular respiration fail to work effectively at higher temperatures, and further increases can lead them to [[变性 (生物化学)|denature]], reducing their ability to catalyse essential chemical reactions. This loss of enzymatic control affects the functioning of major organs with high energy demands such as the heart and brain.

===Situational===
[[File:heat-related deaths.jpg|upright=1.4|thumb|right]]
Situational heat stroke occurs in the absence of exertion. It mostly affects the young and elderly. In the elderly in particular, it can be precipitated by medications that reduce vasodilation and sweating, such as [[抗膽鹼劑|anticholinergic]] drugs, antihistamines, and diuretics.<ref name=Harrisons /> In this situation, the body's tolerance for high environmental temperature may be insufficient, even at rest.

Heat waves are often followed by a rise in the death rate, and these 'classical hyperthermia' deaths typically involve the elderly and infirm. This is partly because thermoregulation involves cardiovascular, respiratory and renal systems which may be inadequate for the additional stress because of the existing burden of aging and disease, further compromised by medications. During the July 1995 heat wave in Chicago, there were at least 700 heat-related deaths. The strongest risk factors were being confined to bed, and living alone, while the risk was reduced for those with working air conditioners and those with access to transportation. Even then, reported deaths may be underestimates as diagnosis can be misclassified as stroke or heart attack.<ref>{{cite journal | title=Heat-related deaths during the July 1995 heat wave in Chicago |vauthors=Semenza JC, Rubin CH, Falter KH, Selanikio JD, Flanders WD, Howe HL, Wilhelm JL | date=July 1996 | journal=N Engl J Med | volume=335 | issue = 2 | pages=84–90 | pmid=8649494 | doi=10.1056/NEJM199607113350203}}</ref>

===Drugs===
Some drugs cause excessive internal heat production.<ref name=Harrisons /> The rate of drug-induced hyperthermia is higher where use of these drugs is higher.<ref name=Harrisons />

* Many psychotropic medications, such as [[选择性5-羟色胺再摄取抑制剂|selective serotonin reuptake inhibitors]] (SSRIs), [[单胺氧化酶抑制剂|monoamine oxidase inhibitors]] (MAOIs), and [[三环类抗抑郁药|tricyclic antidepressants]], can cause hyperthermia.<ref name=Harrisons /> {{tsl|en|Serotonin syndrome||Serotonin syndrome}} is a rare adverse reaction to overdose of these medications or the use of several simultaneously. Similarly, {{tsl|en|neuroleptic malignant syndrome||neuroleptic malignant syndrome}} is an uncommon reaction to [[抗精神病药|neuroleptic]] agents.<ref>{{cite book |title=Emergency Medicine: A Comprehensive Study Guide, Sixth edition |last=Tintinalli |first=Judith |year=2004 |publisher=McGraw-Hill Professional |location= |isbn=0-07-138875-3 |page=1818 |url= }}</ref> These syndromes are differentiated by other associated symptoms, such as tremor in serotonin syndrome and "lead-pipe" muscle rigidity in neuroleptic malignant syndrome.<ref name=Harrisons />
* Various stimulant drugs, including {{tsl|en|amphetamines||amphetamines}},<ref>{{cite book |title=Rosen's emergency medicine: concepts and clinical practice |last=Marx |first=John |year=2006 |publisher=Mosby/Elsevier |location= |isbn=978-0-323-02845-5 |page=2894 |url= }}</ref> [[可卡因|cocaine]],<ref>{{cite book |title=Rosen's emergency medicine: concepts and clinical practice |last=Marx |first=John |year=2006 |publisher=Mosby/Elsevier |location= |isbn=978-0-323-02845-5 |page=2388 |url= }}</ref> {{tsl|en|Phencyclidine||PCP}}, [[D-麦角酸二乙胺|LSD]], and [[MDMA]] can produce hyperthermia as an [[不良反应 (医学)|adverse effect]].<ref name=Harrisons />
* [[恶性高热|Malignant hyperthermia]] is a rare reaction to common anesthetic agents (such as [[氟烷|halothane]]) or the paralytic agent [[琥珀胆碱|succinylcholine]]. Those who have this reaction, which is potentially fatal, have a genetic predisposition.<ref name=Harrisons />
* The use of [[抗膽鹼劑|anticholinergic]]s, more specifically {{tsl|en|muscarinic antagonist||muscarinic antagonist}}s are thought to cause mild hyperthermic episodes due to its parasympatholytic effects. The sympathetic nervous system a.k.a. the "Fight or Flight Response" dominates by raising catecholamine levels by the blocked action of the Rest and Digest System.<ref>{{cite news|last=Patel|first=R.J.|url=http://www.ncbi.nlm.nih.gov/m/pubmed/14751484/|title=Prevalence of autonomic signs and symptoms in antimuscarinic drug poisonings|journal=J. Emerg. Med.|date=January 2004|volume=26|number=1|pages=89–94|display-authors=etal}}</ref>
* Drugs that decouple [[氧化磷酸化|oxidative phosphorylation]] may also cause hyperthermia. From this group of drugs the most well known is [[2,4-二硝基苯酚|2,4-Dinitrophenol]] which was used as a weight loss drug until dangers from its use became apparent.

===Personal protective equipment===
Those working in industry, in the military, or as {{tsl|en|Certified first responder||first responder}}s may be required to wear {{tsl|en|personal protective equipment||personal protective equipment}} (PPE) against hazards such as chemical agents, gases, fire, small arms and even [[簡易爆炸裝置|Improvised Explosive Devices (IEDs)]]. PPE includes a range of hazmat suits, firefighting turnout gear, body armor and {{tsl|en|bomb suit||bomb suit}}s, among others. Depending on design, the wearer may be encapsulated in a microclimate,<ref name=MicroclimateCooling>{{cite web |title=Microclimate Conditioning Systems |publisher=US Army Natick Soldier RD&E Center |url=http://nsrdec.natick.army.mil/media/print/MCC_Systems_Trifold.pdf |date=May 2007 |accessdate=2 August 2015}}</ref> due to an increase in thermal resistance and decrease in vapor permeability. As physical work is performed, the body’s natural thermoregulation (i.e., sweating) becomes ineffective. This is compounded by increased work rates, high ambient temperature and humidity levels, and direct exposure to the sun. The net effect is that desired protection from some environmental threats inadvertently increases the threat of heat stress.

The effect of PPE on hyperthermia has been noted in fighting the [[西非伊波拉病毒疫症|2014 Ebola virus epidemic]] in Western Africa. Doctors and healthcare workers were only able to work 40 minutes at a stretch in their protective suits, fearing heat strokes.<ref>{{cite news |url=http://www.npr.org/2014/10/07/354230895/ebola-protective-suits-are-in-short-supply |title=Ebola Protective Suits Are In Short Supply |first=Jackie |last=Northam |publisher=National Public Radio |date=7 October 2014 |accessdate=21 January 2015}}</ref>

===Other===
Other rare causes of hyperthermia include [[甲状腺功能亢进症|thyrotoxicosis]] and an [[腎上腺|adrenal gland]] tumor, called {{tsl|en|pheochromocytoma||pheochromocytoma}}, both of which can cause increased heat production.<ref name=Harrisons /> Damage to the central nervous system, from brain hemorrhage, [[癲癇重積狀態|status epilepticus]], and other kinds of injury to the hypothalamus can also cause hyperthermia.<ref name=Harrisons />

==Treatment==
The underlying cause must be removed. Mild hyperthemia caused by exertion on a hot day may be adequately treated through self-care measures, such as increased water consumption and resting in a cool place. Hyperthermia that results from drug exposure requires prompt cessation of that drug, and occasionally the use of other drugs as counter measures. Antipyretics (e.g., acetaminophen, aspirin, other nonsteroidal anti-inflammatory drugs) have no role in the treatment of heatstroke because antipyretics interrupt the change in the hypothalamic set point caused by pyrogens; they are not expected to work on a healthy hypothalamus that has been overloaded, as in the case of heatstroke. In this situation, antipyretics actually may be harmful in patients who develop hepatic, hematologic, and renal complications because they may aggravate bleeding tendencies.<ref>{{EMedicine|article|166320|Heatstroke|treatment}}</ref>

When body temperature is significantly elevated, mechanical cooling methods are used to remove heat and to restore the body's ability to regulate its own temperatures.<ref name=Harrisons /> Passive cooling techniques, such as resting in a cool, shady area and removing clothing can be applied immediately. Active cooling methods, such as sponging the head, neck, and trunk with cool water, remove heat from the body and thereby speed the body's return to normal temperatures. Drinking water and turning a fan or dehumidifying [[空氣調節|air conditioning]] unit on the affected person may improve the effectiveness of the body's evaporative cooling mechanisms (sweating).{{citation needed|date=July 2015}}

Sitting in a bathtub of tepid or cool water (immersion method) can remove a significant amount of heat in a relatively short period of time. It was once thought that immersion in very cold water is counterproductive, as it causes [[血管收縮|vasoconstriction]] in the skin and thereby prevents heat from escaping the body core. However, a British analysis of various studies stated: "this has never been proven experimentally. Indeed, a recent study using normal volunteers has shown that cooling rates were fastest when the coldest water was used."<ref name="ReferenceA">{{cite journal |last1=Smith |first1=J E |title=Cooling methods used in the treatment of exertional heat illness |journal=British Journal of Sports Medicine |volume=39 |issue=8 |pages=503–7; discussion 507 |year=2005 |pmid=16046331 |pmc=1725271 |doi=10.1136/bjsm.2004.013466 }}</ref> The analysis concluded that cool water immersion is the most-effective cooling technique for exertional heat stroke.<ref name="ReferenceA"/> No superior cooling method has been found for non-exertional heat stroke.<ref>{{cite journal |last1=Bouchama |first1=Abderrezak |last2=Dehbi |first2=Mohammed |last3=Chaves-Carballo |first3=Enrique |title=Cooling and hemodynamic management in heatstroke: practical recommendations |journal=Critical Care |volume=11 |issue=3 |pages=R54 |year=2007 |pmid=17498312 |pmc=2206402 |doi=10.1186/cc5910 }}</ref> Thus, aggressive ice-water immersion remains the gold standard for life-threatening heat stroke.<ref>{{cite journal |journal=Exerc Sport Sci Rev |date=July 2007 |volume=35 |issue=3 |pages=141–149 |title=Cold water immersion: the gold standard for exertional heatstroke treatment |authors=Casa DJ, McDermott BP, Lee EC, Yeargin SW, Armstrong LE, Maresh CM |pmid=17620933 |doi=10.1097/jes.0b013e3180a02bec}}</ref><ref>{{cite journal |doi=10.4085/1062-6050-44.1.84 |title=Acute Whole-Body Cooling for Exercise-Induced Hyperthermia: A Systematic Review |year=2009 |last1=McDermott |first1=Brendon P. |last2=Casa |first2=Douglas J. |last3=Ganio |first3=Matthew S. |last4=Lopez |first4=Rebecca M. |last5=Yeargin |first5=Susan W. |last6=Armstrong |first6=Lawrence E. |last7=Maresh |first7=Carl M. |journal=Journal of Athletic Training |volume=44 |pages=84–93 |pmid=19180223 |issue=1 |pmc=2629045}}</ref>

When the body temperature reaches about 40&nbsp;°C, or if the affected person is unconscious or showing signs of confusion, hyperthermia is considered a {{tsl|en|medical emergency||medical emergency}} that requires treatment in a proper medical facility. In a hospital, more aggressive cooling measures are available, including [[靜脈注射|intravenous]] hydration, {{tsl|en|gastric lavage||gastric lavage}} with iced saline, and even [[血液透析|hemodialysis]] to cool the blood.<ref name=Harrisons />
{{trans F}}
{{medical-stub}}
{{medical-stub}}


2017年8月25日 (五) 04:26的版本

维基百科中的醫學内容仅供参考，並不能視作專業意見。如需獲取醫療幫助或意見，请咨询专业人士。詳見醫學聲明。
体温过高
一个仿真醫療溫度計，显示体温读数为38.7 °C（101.7 °F）
类型high fever[*]
分类和外部资源
醫學專科重症醫學
ICD-9-CM780.6
DiseasesDB18924
MedlinePlus[1]
MeSHD005334
[编辑此条目的维基数据]
  关于与「高熱」標題相近或相同的条目页，請見「发热_(消歧義)」。

体温过高[1]（英語：Hyperthermia）是指由于體溫調節失衡而导致的体温升高的症状。当身体吸收热量高于散发热量时，这种症状便会出现，而若是出现急剧的体温升高症状的话，则需送往医疗急诊（英语：medical emergency）进行立刻治疗，以免耽搁导致伤残甚至死亡。

该症状最常见的成因包括中暑、药物副作用等。前者是因暴露在过量热量、湿度下的体温急性升高，超过了一般的热量控制系统所能承受的最大范围。而后者则是许多药物（尤其是那些影响到中樞神經系統的药物）的一种比较罕见的副作用。此外， 某些全身麻醉也可能会导致恶性高热。

体温过高和发燒不同，前者的体温调定点自始至终保持不变。和体温过高相对的是失溫症，指的是体温低于日常新陈代谢所需的温度的情况。

分類

體溫分類
核心（英语：Core_temperature#Core_temperature） （直腸，食道等）
低溫 <35.0 °C（95.0 °F）[2]
正常 36.5—37.5 °C（97.7—99.5 °F）[3]
發燒 >37.5或38.3 °C（99.5或100.9 °F）[4][5]
高熱症 >40.0或41.5 °C（104.0或106.7 °F）[6][7]
注意：發燒和高燒之間的差異是潛在的機制結果。
不同的來源有不同的臨界值用於發燒，高燒.

参考资料

  1. ^ hyperthermia - 體溫過高. terms.naer.edu.tw. [2017-06-26] （中文（臺灣））. 
  2. ^ Marx, John. Rosen's emergency medicine: concepts and clinical practice. Mosby/Elsevier. 2006: 2239. ISBN 978-0-323-02845-5. 
  3. ^ Karakitsos D, Karabinis A. Hypothermia therapy after traumatic brain injury in children. N. Engl. J. Med. September 2008, 359 (11): 1179–80. PMID 18788094. doi:10.1056/NEJMc081418. 
  4. ^ 4.0 4.1 Axelrod YK, Diringer MN. Temperature management in acute neurologic disorders. Neurol. Clin. May 2008, 26 (2): 585–603, xi. PMID 18514828. doi:10.1016/j.ncl.2008.02.005. 
  5. ^ 5.0 5.1 Laupland KB. Fever in the critically ill medical patient. Crit. Care Med. July 2009, 37 (7 Suppl): S273–8. PMID 19535958. doi:10.1097/CCM.0b013e3181aa6117. 
  6. ^ Manson's Tropical Diseases: Expert Consult. Saunders. 2008: 1229. ISBN 978-1-4160-4470-3. 
  7. ^ Trautner BW, Caviness AC, Gerlacher GR, Demmler G, Macias CG. Prospective evaluation of the risk of serious bacterial infection in children who present to the emergency department with hyperpyrexia (temperature of 106 degrees F or higher). Pediatrics. July 2006, 118 (1): 34–40. PMC 2077849 可免费查阅. PMID 16818546. doi:10.1542/peds.2005-2823. 
  8. ^ 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 8.10 8.11 8.12 8.13 8.14 Fauci, Anthony; et al. Harrison's Principles of Internal Medicine（英语：Harrison's Principles of Internal Medicine） 17th. McGraw-Hill Professional. 2008: 117–121. ISBN 978-0-07-146633-2. 
  9. ^ Tintinalli, Judith. Emergency Medicine: A Comprehensive Study Guide, Sixth edition. McGraw-Hill Professional. 2004: 1187. ISBN 0-07-138875-3. 
  10. ^ Semenza JC, Rubin CH, Falter KH, Selanikio JD, Flanders WD, Howe HL, Wilhelm JL. Heat-related deaths during the July 1995 heat wave in Chicago. N Engl J Med. July 1996, 335 (2): 84–90. PMID 8649494. doi:10.1056/NEJM199607113350203. 
  11. ^ Tintinalli, Judith. Emergency Medicine: A Comprehensive Study Guide, Sixth edition. McGraw-Hill Professional. 2004: 1818. ISBN 0-07-138875-3. 
  12. ^ Marx, John. Rosen's emergency medicine: concepts and clinical practice. Mosby/Elsevier. 2006: 2894. ISBN 978-0-323-02845-5. 
  13. ^ Marx, John. Rosen's emergency medicine: concepts and clinical practice. Mosby/Elsevier. 2006: 2388. ISBN 978-0-323-02845-5. 
  14. ^ Patel, R.J.; et al. Prevalence of autonomic signs and symptoms in antimuscarinic drug poisonings 26 (1). January 2004: 89–94.  |journal=被忽略 (帮助)
  15. ^ Microclimate Conditioning Systems (PDF). US Army Natick Soldier RD&E Center. May 2007 [2 August 2015]. 
  16. ^ Northam, Jackie. Ebola Protective Suits Are In Short Supply. National Public Radio. 7 October 2014 [21 January 2015]. 
  17. ^ Heatstroke 於 eMedicine
  18. ^ 18.0 18.1 Smith, J E. Cooling methods used in the treatment of exertional heat illness. British Journal of Sports Medicine. 2005, 39 (8): 503–7; discussion 507. PMC 1725271 可免费查阅. PMID 16046331. doi:10.1136/bjsm.2004.013466. 
  19. ^ Bouchama, Abderrezak; Dehbi, Mohammed; Chaves-Carballo, Enrique. Cooling and hemodynamic management in heatstroke: practical recommendations. Critical Care. 2007, 11 (3): R54. PMC 2206402 可免费查阅. PMID 17498312. doi:10.1186/cc5910. 
  20. ^ Casa DJ, McDermott BP, Lee EC, Yeargin SW, Armstrong LE, Maresh CM. Cold water immersion: the gold standard for exertional heatstroke treatment. Exerc Sport Sci Rev. July 2007, 35 (3): 141–149. PMID 17620933. doi:10.1097/jes.0b013e3180a02bec. 
  21. ^ McDermott, Brendon P.; Casa, Douglas J.; Ganio, Matthew S.; Lopez, Rebecca M.; Yeargin, Susan W.; Armstrong, Lawrence E.; Maresh, Carl M. Acute Whole-Body Cooling for Exercise-Induced Hyperthermia: A Systematic Review. Journal of Athletic Training. 2009, 44 (1): 84–93. PMC 2629045 可免费查阅. PMID 19180223. doi:10.4085/1062-6050-44.1.84. 
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