摘要
目的 :评估急性高原病 (AHD)合并多脏器功能障碍综合征 (MODS)的诊断标准和依据。方法 :参照平原MODS诊断标准对高原现场救护和转院的AHD病例进行回顾性调查 ,锁定原发病因为高原脑水肿 (HACE)、高原肺水肿 (HAPE)为调查对象 ,重点收集与心、肺、脑、肾、肝、血液、肠、代谢八个脏器相关的功能指标 ,按庐山 (1995) ,Marshall(1995) ,兰州 (1999)有关MODS/ARDS评分诊断对各脏器损害程度进行综合评分。结果 :9例均在急进高原 450 0～ 470 0m后急性发病 ,发病至诊治时间平均≥ 2 0 .6h。全组均在发生AHD后进行现场救护 ,其中 6例无效转入上一级医院 5～ 9d死于MODS。 9例中原发病因为HACE 5例 ,HAPE4例。可明确脏器损害者共有 44个脏器 ,平均每例 4.9个脏器受损 ;其中达到脏器衰竭标准共有 3 4个脏器 ,平均为3 .8个脏器衰竭。 9例中 5例进行APACHE -Ⅱ评分 ,分值最低为 15分 ,最高 2 7分 ,平均 2 1.7分。结论 :①HACE或HAPE不是单一脏器受损 ,而是多脏器受损 ,MODS是导致死亡的最危险因素 ;②及时有效地现场救治可能是阻断病情发展。
Objective: To evaluate the diagnostic in dicator parameters and diagnostic criteria of multiple organ dysfunction syndrome (MODS) complicated from acute mountain sickness (AHD). Me thods: Referring to the diagnostic criteria of MODS on plain, 9 cases with acute high altitude cerebral edema (HACE) and acute high alt itude pulmonary edema (HAPE) were analysed retrospectively. The functional parameters of eight organs or systems were colle cted including heart, lung, brain, liver, kidney, gastro-intestinal tract, blood and metabolic system. The MODS scorings w ere carried out according to the diagnostic criteria of Lushan Conference, Marshall(1995) and Lanzhou criteria drafted by th e authors, scorings of APACHE-II were made to predict the outcome of MODS. Results: 9 cases all occurred after rapid entry into altitude 4 500 m to 4 700 m and were given the treatment on the spots with a mean time of 20.6 h, in which the primar y causes were HACE (5 cause) and HAPE (4 cause) ,6 cases died of MODS after tran sferring to the second class hospital 5 to 9 days. 44 organs were injured in 9 cases and the mean injuring organ was 4.9, in which 34 reached the organ failure indications and the mean value was 3.8. The scorings of APACHE-II were from 15 to 27 and the mean value w as 21.7. Conclusion: ①HAPE or/and HACE were not single organ injury but multiple organs injuries. AHD complicating MODS is t he most dangerous factor to death. ②The prompt and effective treatment on the spot might be an important method in block ing the development of the illness and reversing the dangerous ending.
出处
《西北国防医学杂志》
CAS
2004年第1期7-9,共3页
Medical Journal of National Defending Forces in Northwest China
基金
全军"十五"医药卫生指令性课题基金资助项目(01L003)
