临床症状与体征在高原肺水肿早期诊断中的意义  

Significance of Clinical Symptoms and Physical Signs in Early Diagnosis of High-altitude Pulmonary Edema

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

机构地区：[1]西藏军区总医院高山病科,西藏拉萨850007

出　　处：《华南国防医学杂志》2010年第2期87-89,111,共4页Military Medical Journal of South China

基　　金：国家科技支撑计划课题(2009BAI85B05)

摘　　要：目的对临床症状、体征在高原肺水肿(high-altitude pulmonaryedema,HAPE)早期诊断中的意义进行探讨。方法应用急性轻型高原病症状分度及评分表,对24200例急进高原人员进行筛选。筛选出高度疑似HAPE者作为重点观察及随访对象,并给予卧床休息及吸氧,观察过程中上述症状、体征无明显缓解,甚至加重或出现咳白色泡沫痰者及时送医院行相关检查、诊断及治疗。对所有重点观察及随访对象的症状、体征变化进行逐一登记,对最终确诊为HAPE的对象及非HAPE对象的早期症状、体征进行归纳分析。结果24200例急进高原人员中,高原症状评分大于4分的4124例,筛选出重点观察对象482例,确诊HAPE病例142例。两组临床症状、体征比较,心慌、胸闷、呼吸困难、咳嗽、咳痰、手足发麻、脉搏、呼吸频率、口唇紫绀、肺部局部呼吸音粗糙、肺部湿罗音、心脏听诊(P2>A2)差异具有统计学意义(0.05>P<0.01);确诊HAPE患者平均发病时间为(36.97±19.02)h;重点观察及随访对象中HAPE组临床症状、体征缓解时间明显比非HAPE组延长,两组比较差异具有统计学意义(0.05>P<0.01)。结论HAPE患者早期临床症状、体征具有一定的特点,加强急进高原者早期症状、体征的观察,对HAPE的早期诊断具有重要意义。Objective To explore the significance of clinical symptoms and physical signs in the early diagnosis of high-altitude pulmonary edema （HAPE）. Methods A survey was performed in 24 200 adults who immediately entered into high-altitude plateau in recent two years. People who were highly suspected as having HAPE were selected for inves- tigation and were prescribed bed rest and low flow oxygen inhalation when necessary. Subjects who could not be relieved of symptoms and signs or expectorated white frothy sputum were sent to hospital in time. The changes of their symptoms and physical signs in a week after they entered into high-altitude plateau were analysed. Results In the 24 200 subjects entering high-altitude plateau, there were 4124 persons with a symptom score ~4, from whom 482 were selected for final investigation, and 142 were diagnosed as having HAPE. The symptoms and physical signs, including palpitation, chest distress, dyspnea, cough, expectoration, numbness of hands and feet, pulse, breath frequency, oral cyanosis, coarse breath sounds, active P2 sound, and pulmonary crackles were significantly different between two groups （P〈0. 05, P% 0. 01）. The time for the symptomatic relieve and improvement of physical signs were also different between the two groups （P〈0.05, P〈0. 01）. The mean occurrence time was （36. 97 ±19. 02）h. Conclusion The symptoms and physical signs of HAPE have some definite characters. Reinforcing the investigation of symptoms and physical signs in people who immediately enter into high-altitude plateau has important meanings for early diagnosis of HAPE.

关 键 词：高原肺水肿 早期诊断 症状 体征 

分 类 号：R541.63[医药卫生—心血管疾病]