高原肺水肿的早期识别预警研究  

Early warning of high altitude pulmonary edema

作　　者：李高元 李宗斌[2] 张进武 姜俊杰[1] 胡安忠[1] 刘安恒[4] 

机构地区：[1]解放军22医院 [2]解放军总医院心血管内科 [3]62217部队卫生队 [4]军事医学科学院附属医院心血管内科

出　　处：《军事医学》2015年第4期254-256,共3页Military Medical Sciences

摘　　要：目的通过对急性轻型高原病(急性高原反应,AMS)及高原肺水肿(HAPE)的临床症状、心率(HR)、动脉氧饱和度(Sa O2)及白细胞(WBC)计数的分析,探讨上述指标对HAPE早期预警的意义。方法以628名初入昆仑山的驻训人员为研究对象,按照急性高原病路易斯湖评分系统(LLSS)和临床出现的呼吸系统症状评分的总分归入:A组(健康组,评分<3分),B组(AMS组,至少1次评分>3分,排除HAPE)、C组(HAPE组),比较各组临床症状发生情况及HR、Sa O2,并对部分对象进行WBC计数分析。结果 C组呼吸系统症状发生率及WBC计数较B组明显升高(P<0.05);初入高原3 d内,A、B两组平均HR呈逐渐下降趋势,而C组平均HR却逐渐上升,且在第3天较A、B两组明显升高(F=6.37,P<0.05);C组Sa O2在第1、2、3天明显低于A、B两组(F=8.21,F=8.77,F=9.58,P<0.01)。结论初入高原人群中,出现呼吸系统症状、WBC计数升高、HR无适应性下降及Sa O2显著减低(>30%)者发生HAPE的风险明显增加,这些变化对早期识别预警HAPE具有重要意义。Objective By analyzing the clinical symptoms, heart rate （ HR）, arterial oxygen saturation （ SaO2 ） and the number of white blood cells （ WBC）, we aimed to explore the implication of the above-mentioned indexes for early warning of high altitude pulmonary edema （HAPE）. Methods Based on the Lake Louise Self-assessmeat Scoring System （LESS） and the scoring of respiratory symptoms, 628 subjects were divided into three groups： group A （the healthy; score 〈 3）, group B（ acute mountain sickness, AMS ; score 〉 3 and excluding HAPE） , and group C （HAPE）. Moreover, we analyzed the incidence of some clinical symptoms, HR and SaO2 , as well as the WBC number of some subjects in the three groups. Results The incidence of respiratory symptoms and WBC number were significantly increased in group C compared with group B （ P 〈 0.05 ）. In addition, unlike group A and B, the mean HR in group C rose gradually in the first 3 days and was markedly increased at the third day（ F = 6. 37 ,P 〈 0.05）. The mean SaO2in group C was remarkably lower than in group A and B in the first 3 days （F = 8. 21, F = 8. 77, F = 9. 58, P 〈 0. 01 ）. Conclusion Those who enter high altitude for the first time with notable respiratory symptoms, WBC increase, HR maladaptation and decrease in SaO2 （ 〉 30% ） have high risk of HAPE. It is of special importance to detect HAPE earlier at high altitude.

关 键 词：肺水肿 急性高原病 白细胞计数 心率 动脉氧饱和度 

分 类 号：R594.3[医药卫生—内科学]