初进高原者耐缺氧机制与高原条件下的输血策略  

Anti-hypoxia mechanism and blood transfusion strategies for new arrivals on plateau

作　　者：李翠莹[1] 李小薇[1] 

机构地区：[1]空军总医院输血科,北京100142

出　　处：《中国输血杂志》2017年第8期859-862,共4页Chinese Journal of Blood Transfusion

基　　金：全军后勤科研重大专项子项(AWS13J004)

摘　　要：高原环境中的低压低氧、寒冷干燥及紫外线强等均是对机体不利的因素,平原人群进入高原难免发生一系列生理改变。平原人群在高原地区负(战、创)伤时,不仅表现为失血耐受能力降低、易发生休克,而且对液体耐受能力更小,使得脑水肿、肺水肿、右心功能不全以及多器官衰竭早等较易发生。失血是导致伤者的这些病状,乃至死亡的关键原因,而输血治疗也成为高原战创伤救治中更重要的手段。本文首先对本期"高原输血专题"中涉及的平原人群进入高原后血常规变化、高原适应基因表达改变、红细胞形态及携氧功能差异等方面研究作了评述,并分析总结了其中的变化规律及意义,以提高平原人群高原习服适应能力;其次针对高原低氧环境下藏、汉族人群发生高原战创伤时异于平原地区人群的特征,概述了有关高原失血性休克患者的输血策略、特点及其救治的研究进展,分析了高原适应机制与之的相关性;最后针对高原输血目前存在的困窘与亟待解决的问题,提出并探讨了自己的高原的输血策略。There are some adverse factors, such as hypobaric hypoxia, cold drying and strong ultraviolet radiation, in the plateau environment. A series of physiological changes will occur in the plain population when migrating into plateau. The plain population is characterized by low blood loss tolerance, easy to shock, small tolerance to fluid, easy to occur brain ede- ma, pulmonary edema, right heart failure and multiple organ failure when the trauma occurs after rush entry into plateau. Blood loss resultes in these symptoms mentioned above, and even death, thus blood transfusion is a more important strategy for trauma treatment. In order to improve the hypoxia acclimatization of plain people, we first commented on the changes of the blood routine, the hypoxia gene expression, the red blood cell morphology and the oxygen delivering capacity differences after the plain people rush entry into plateau, and analyzed and summarized the rule and significance of these changes. Then, according to the different characteristics between Tibetan and Hart population after trauma occured, we summarized the treatment of hemorrhagic shock, and analyzed its correlation with the plateau adaptiven mechanism . Finally, in view of the current problems and difficulties of blood transfusion in the Tibetan Plateau, we explore the plateau adaptive mechanism and the blood transfusion strategy under the plateau condition.

关 键 词：高原输血策略 高原低氧适应 失血性休克 失血耐受 高原适应基因 红细胞形态 红细胞携氧 

分 类 号：R457.1[医药卫生—治疗学] R135.6[医药卫生—临床医学]