高原肺水肿早期诊断标准的探讨  

Diagnostic Criteria for High Altitude Pulmonary Edema in the Early Stage

作　　者：李素芝[1] 郑必海[1] 闫春城[1] 王宇亮[1] 郑建保[2] 陈彬[3] 董学文[1] 廖国云[1] 杨定周[1] 谭健[4] 刘斌[4] 刘晓波[5] 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 [2]西藏军区总医院干部病房,西藏拉萨850007 [3]西藏军区总医院心脏内分泌科,西藏拉萨850007 [4]西藏军区总医院医学影像科,西藏拉萨850007 [5]西藏军区总医院特诊科,西藏拉萨850007

出　　处：《华南国防医学杂志》2010年第3期161-165,170,共6页Military Medical Journal of South China

基　　金：国家科技支撑计划课题(2009BAI85B05)

摘　　要：目的探讨高原肺水肿(high altitude pulmonary edema,HAPE)的早期诊断标准。方法对筛选出的高度疑似HAPE对象进行重点观察及随访,通过对其中非HAPE组及确诊HAPE组的早期症状、体征及辅助检查进行对照分析,筛选并制定出HAPE的早期诊断标准。结果高原肺水肿的早期诊断标准:①近期进入高原(海拔3000m以上),静息状态下出现心慌、胸闷、呼吸困难、咳嗽、有或无少量咳白色泡沫痰。②局部或一侧、双侧呼吸音粗糙,有或无局部湿啰音,中央型紫绀、心动过速(>100/min)、呼吸频率增快(>24/min)。③早期常规X线检查,可表现为肺内透光度降低、肺纹理增多或模糊、肺内呈磨玻璃样改变或小片状影。CT扫描主要表现为肺纹理增粗增多、磨玻璃样改变、小结节样影、散在或孤立终末支气管肺泡水肿、纤细网纹状影。④血常规检查,可见白细胞总数及中性粒细胞比率升高。⑤动脉血气检查,可表现出持续性的低氧血症,并伴轻度呼吸性碱中毒。⑥心电图检查可表现为窦性心动过速、顺钟向转位、P波高尖等。⑦超声心动图检查,可表现为早期显著的持续性肺动脉高压。⑧经卧床休息、吸氧、降低肺动脉压及利尿等治疗,症状迅速好转。结论早期HAPE在临床症状、体征及相关辅助检查方面均存在一定的特征性改变,在具备结果①、②、③的条件下,结合④、⑤、⑥、⑦、⑧即可对早期HAPE作出准确诊断。Objective To explore the diagnostic criteria for high altitude pulmonary edema （HAPE） in the early stage.Methods Subjects who were highly suspected as HAPE were observed and followed up.The symptoms,physical signs,results of complementary examinations （including routine blood tests,blood biochemical and blood gas analysis,EEG,TCD,CT and MRI） were compared between the HAPE and non-HAPE groups.The diagnostic criteria for HAPE in the early stage were summarized.Results The diagnostic criteria included：① entering plateau （more than 3000 meters above sea level） from plain,with palpitation,chest distress dyspnea,cough with or without white foam sputum in the resting state;② coarse breath sounds,with or without moist rales,central,pyknocardia （100/min）,increase of breathing rates （24/min）;③ decrease of pulmonary transmittance,increase of pulmonary markings,ground-glass opacity-like lesions or small lamellar shadows in early routine X-ray;increase of pulmonary markings,ground-glass appearance,small nodule-like shadows,diffused and single terminal bronchovesicular edema,fine mesh-like shadow in CT;④ increase of white blood cell count to neutrophil ratio;⑤ persistent hypoxemia complicated by slight respiratory alkalosis;⑥ pyknocardia,clockwise rotation,high and sharp P-waves;⑦ significant and continuous pulmonary artery hypertension indicated by ECHO;⑧ rapid improvement of the symptoms after oxygen inhalation,reducing pulmonary arterial pressure and diuretic treatment.Conclusion There are some specific changes of symptoms,physical signs and related assistant examination results in the early stage of HAPE.Criteria ①,②,③ are the necessary conditions,in combination with criteria ④,⑤,⑥,⑦ and ⑧,for accurate diagnosis of HAPE in the early stage.

关 键 词：高原肺水肿 早期特征 诊断标准 

分 类 号：R135.6[医药卫生—劳动卫生]