熱中症

ばく

熱中症のメカニズムを理解して、暑さなんてすっ飛ばせ！

環境や運動によりどんなに高温状況でも、人体の受動的な冷却システムである血管拡張（放射熱）と、能動的な冷却システムである発汗（気化熱）のバランスが取れていれば、体温は正常に維持されます。高温状況が、体の冷却システムを超える、もしくは冷却システムが水分の摂取と放出のバランスが崩れ、機能しなくなることにより、体温が40.5℃を超えた状態を熱射病と言います。体温が42℃を越えると、体の酵素反応に必要なタンパク質が変質し、急速にさまざまな器官不全が起こり、死に至る可能性があります。

熱射病には、脱水状態（水分不足）が原因で、体の冷却システムが機能しない熱疲労の処置を失敗するルートと、過度の高温状況や激しい運動により、冷却システムを超えて熱射病になる２つのルートがあります。つまり、どんなに水分を摂取していても、熱射病の可能性はあります。日焼けは、皮膚の汗せん、毛細血管を破壊し、体の冷却システムを奪い、熱疲労を促進します。一方、熱中症の予防のために過剰に水分を摂取すると、体内の電解質濃度が低下し、低ナトリウム症と言う状態になり、深刻な場合は死に至ります。高温状況による問題を熱中症という一つの問題と誤解することにより、低ナトリウム症の予防、評価、処置を失敗します。

細胞が正常に機能するためには、電気的化学反応による交信が必要です。体液に適当な濃度の電解質が溶解していることにより、この電気的交信が可能となります。ナトリウムは細胞外液の基本的な電解質であり、カリウムは細胞内液の基本的な電解質です。これらは汗や尿から排出常にされ、体内の貯蓄に限界があり、経口か点滴で補充するしかありません。高温状況では、順化できていない人は、通常より30-50%多くのナトリウムを損失します。骨格筋の中のナトリウムが低下すると、攣りや痙攣が起こります。脳組織は、ナトリウムを組織内に保存しようとするため、ナトリウム濃度を一定に保つために、脳組織内に水が移動します。この結果、脳が腫れを起こし、吐き気、嘔吐、最終的には脳幹の圧迫により死に至る可能性があります。

熱疲労と低ナトリウム症の症状、バイタルに見分けがつきませんが、熱疲労の尿は濃く量が少なく、低ナトリウム症の尿は透明で量が多いため、適切な評価と処置をするためには、尿の状態を注意深く観察することが大切です。熱疲労には水分が必要で、低ナトリウム症状には電解質が必要と処置が異なります。さらに、重要なことは、全ての熱中症の予防には、水分だけを与えず、低ナトリウム症の予防のために、必ず電解質も与えることです。

現在、経口補水液：ORS（Oral Rehydration Solution）が市販されるようになりました。これは、塩分とブドウ糖を適切は配分で溶かしたものです。実際アウトドアに、ペットボトルを大量に持っていくことはできませんので、私は、レモネードの粉末に、少量の食塩を加えて、自作でORSを作っています。

いよいよ夏本番、私たちの体は、新型コロナウィルスで室内にいることが多く、高温状況に順応していません。熱中症を、熱疲労、熱射病、低ナトリウム症を分けて捉え、適切に評価と処理をしましょう。

暑い夏に元気いっぱい活動できるように、今からどんどんアウトドアに出かけ、しっかり日焼け止めをして、ORSを摂りながら、少しずつ日光に体を慣らしていきましょう。

熱中症を理解したら、ケーススタディにチャレンジしてみましょう。

ご興味のある方はぜひ無料のメルマガにご登録ください。

熱中症に関する詳しい情報はデジタルハンドブックを参照してください。正確な評価と適切な予防・処置のためにはWFA/WFRコースでトレーニングを受けることをお勧めします。深刻な熱中症の評価と処置はSOAPノートに正しく記録することをお勧めします。

Author: Paul Nicolazzo/ Translator: Taito Okamura

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