血常规、血气及血生化改变在高原肺水肿早期诊断中的意义  

Significance of changes of blood examination,arterial blood gas and blood biochemistry in early diagnosis of high altitude pulmonary edema

作　　者：李素芝[1] 郑必海[1] 王宇亮[1] 闫春城[1] 谭健[1] 李珣[1] 鲁茸七林[1] 

机构地区：[1]西藏军区总医院全军高山病中心,拉萨850007

出　　处：《西南国防医药》2010年第4期415-417,共3页Medical Journal of National Defending Forces in Southwest China

基　　金：国家科技支撑计划课题(2009BAI85B05)

摘　　要：目的对血常规、血气及血生化改变在高原肺水肿(HAPE)早期诊断中的意义进行探讨。方法应用急性高原反应症状评分表,对24200例急进高原人员进行评分,筛选出高度疑似HAPE患者作为重点观察及随访对象,并给予卧床休息及吸氧。对所有重点观察及随访对象的血常规、血气及血生化(含电解质、肝功、肾功)变化情况进行检测分析。结果重点观察对象中,确诊HAPE组进入高原第1、2、3d的血白细胞总数(WBC)及中性粒细胞比率(N)均显著高于非HAPE组(P<0.01);两组血气结果比较,HAPE组氧分压(PaO2)、二氧化碳分压(PaCO2)、动脉血氧饱和度(SaO2)及氧合指数(FiO2/PaO2)在进入高原第1、2d均显著低于非HAPE组(P<0.01),HAPE组pH值显著高于非HAPE组(P<0.01);两组血生化比较,HAPE组除钾(K+)第2d显著低于非HAPE组外,各指标均无显著差异。结论早期白细胞计数增加及低氧血症持续性进行性加重与HAPE的发病有着密切的关系,加强疑似HAPE患者早期血常规及动脉血气的监测,有利于HAPE的早期诊断。Objective To explore the significance of changes of blood examination, arterial blood gas and blood biochemistry in the early diagnosis of high altitude pulmonary edema （HAPE）. Methods 24 200 adults who arrived at high altitude rapidly were evaluated according to acute high altitude reaction scale, and then those highly suspected as HAPE were selected for further observation while resting in bed and inhaling oxygen. The changes of blood examination, arterial blood gas and blood biochemistry including electrolytes, liver function and renal function in all observed subjects were measured and analyzed in a week after they arrived at high altitude. Results WBC and ratio of neutral granulocytes in HAPE group were significantly higher than those in non - HAPE group on clay 1,2,3 after they arrived at high altitude （P 〈 0.01 ）. PaO2, PaC02, SaO2 and oxygenation index （FiO2/PaO2 ） in HAPE group were significantly lower than those in non - HAPE group on day 1,2 after they arrived at high altitude （ P 〈 0. 01 ） , whereas pH in HAPE group was significantly higher than that in non - HAPE group at the same time （ P 〈 0. 01 ）. There were no significant differences in the indexes of blood biochemistry except that potassium ion concentration in HAPE group was significantly lower on day 2 than that in non - HAPE group. Conclusion Increased blood white cells and continuous hypoxemia aggravated progressively may be closely related to HAPE. Strengthening the early monitoring of blood examination and arterial blood gas in suspected HAPE patients may be helpful to the early diagnosis of HAPE.

关 键 词：高原肺水肿 血常规 血气 血生化 早期诊断 

分 类 号：R594.3[医药卫生—内科学]