高原地区全身炎症反应综合征与急性高原病发病机制的初步探讨  

Study of pathogenesis of acute mountain sickness and SIRS

作　　者：张世范[1] 张德海[1] 高炜[1] 刘惠萍[1] 朱运奎[1] 刘传兰[1] 陆文胜[1] 

机构地区：[1]兰州军区兰州总医院,甘肃兰州730050

出　　处：《中国现代医学杂志》2006年第2期183-187,共5页China Journal of Modern Medicine

基　　金：全军医药科研技术研究"十五"计划指令性课题(01-L003)

摘　　要：目的探讨高原地区全身炎症反应综合征(SIRS)与急性高原病(AHAS)的发病特点、机制及相互关系。方法通过高原(低氧)和平原(常氧)+内毒素诱导的绵羊肺淋巴造瘘急性肺损伤(ALI)动物模型,比较高原(AG)和平原(FG)两组肺动脉压(Ppa)、肺嵌压(PAW)、动脉血氧分压(PaO2)、肺水质量[肺淋巴流量(Lung lymph flow,QL)、肺通透表面积(Permeability surface area,PS)、肺淋巴液蛋白和血浆蛋白含量比值(L/P)];通过统一的SIRS评分标准对平原地区(海拔430m,西安)和中度高原地区(海拔1517m、2261m,兰州、西宁)ICU患者和胸外科开胸病例进行对照研究,对比观察术后SIRS、MODS评分的变化趋势、发病率和结局的差异。结果平原地区急性肺损伤(ALI)动物模型的Ppa、PWP、QL、PS、L/P和高原地区(3780m)相比差异非常显著,P<0.01;平原ICU患者满足SIRS诊断标准二项、三项及四项标准的发病率分别为59.1%、27.2%和12.1%;2个脏器和3个脏器满足MODS评分诊断者分别为50.0%、56.1%。中度高原(1517m)地区ICU病人,满足SIRS二、三及四项标准者分别为91.2%、78.9%和38.6%;2个和3个脏器满足MODS评分诊断标准者分别为66.7%、28.1%。在平原地区开胸术后的PaO2全部≥80mmHg,中度高原地区(1517m、2261m)全部≤60mmHg。结论由内毒素和/或缺氧诱导的急性肺损伤早期可能有共同发病基础,同属混合型肺水肿性质。高原重创刺激可进一步加重低氧血症,启动全身炎症反应效应,其量化指标在≥1500m地区已变的有统计学意义。【Objective】 To study the characteristic, pathogenesis and the relationship of acute mountain sickness （AMS） and SIRS at high altitude. 【Methods】 The sheep models of acute lung injury（ALI） induced by endotoxin were established to compare puhnonary arterial pressure （Ppa）, pulmonary wedge pressure（PWP）, arterial oxygen partial pressure （PaO2）, lung lymph flow （QL）, pulmonary permeability surface area（PS） and the ratio of lung lymphatic and plasma protein （L/P） between the group of highland （AG, n=5） and flatland （FG, n=7）. Through reviewing and analyzing retrospectively the similar critical severe cases in ICU in plain areas （Shanghai and Xi＇an, altitude 5～430 m） and moderate high altitude areas （Lanzhou and Xining, altitude 1 517～2661 m）, the scores of SIRS and MODS were cartied out to compare the differences of the functional parameters of organs or systems and the ending at different altitude. 【Results】 There were significant difference between the Ppa, PWP, QL, PS and L/P at highland and that on flatland （P 〈 0.01）. The research of clinical ICU cases revealed that the morbidities of flatland patients accorded with two, three or four items of the diagnostic criteria of SIRS were 59.1%, 27.2% and 12.1% respectively and accorded with MODS scoring criteria were 50.0% （two organs） and 56.1% （three organs）. Compared with that in moderate high ahitude areas, the morbidities accorded with two, three or four items of the diagnostic criteria of SIRS were 91.2%, 78.9% and 38.6% respectively and accorded with MODS scoring criteria were 66.7% （two organs） and 28.1% （three organs）. 【Conclusions】 Although populations at moderate high ahitude areas had good adaptive capacity, any relatively severe stimulus might be potential dangerous factor to induce hypoxia and acute fluctuation of oxygen dissociation curve and then initiate more severe stress/inflammatory rcaction compared with that on plain, the quantified criteria of which had beco

关 键 词：急性高原病 急性高原反应与全身炎症反应 MODS 发病机制 平原与高原 

分 类 号：R599[医药卫生—内科学]