高海拔1500m与2400m严重创伤后诱发急性肺损伤的对比观察

目的：探讨不同海拔梯度创伤性急性肺损伤ＡＬＩ／ＡＲＤＳ发病特征和早期诊治。方法：按ＡＩＳ－ＩＳＳ记分标准将院内记分在２０分或以上多发伤病例分为１５００ｍ（兰州）梯度组Ａ组和２２６０～２４００ｍ（西宁和玉门）梯度组Ｂ组，观察两组自受伤～院内救护至发生ＡＬＩ／ＡＲＤＳ的时间、发病特点、血气变化。结果：在伤情相近，原发伤处理相近的条件下，Ｂ组ＡＲＤＳ临床过程、发病机率及其监测指标显著早于、重于、多于Ａ组，Ｐ〈０．０１或Ｐ〈０．０５，但死亡率两组相近。结论：高海拔区创伤性ＡＬＩ／ＡＲＤＳ可能具有缺氧／创伤双重打击因素和高压性／高渗性混合性水肿双重病生性质。诊断标准应异于平原。

Contrast observation of acute lung injury after serious trauma between 1 500 and 2 400 meters above sea level

Objective:[WT5BZ]To study the pathogenic characteristics,diagnosis and treatment in the early stage of traumatic acute lung injury at different elevations.[WT5HZ]Methods:[WT5BZ]The patients with multiple injuries,whose scores reached 20 or more according to AIS-ISS standard,were divided into two groups.Group A was in 1 500 meters above sea level(Lanzhou),and group B in 2 260-2 400 meters above sea level(Xining and Yumen).Pathogenic times,pathogenic characteristics and the changes of blood gases of ALI/ARDS from two groups were observed respectively.[WT5HZ]Results:[WT5BZ]Under the conditions of similar injury and similar primary treatment,clinical manifestations,incidence and monitoring data of ARDS in group B were obviously earlier and more serious than those in group A( P <0.01 or P <0.05).There were no differences in mortality between two groups.[WT5HZ]Conclusion:[WT5BZ]Oxygen deficit and trauma might play important roles in traumatic ALI/ARDS in high altitude,hypertensive pulmonary edema and high altitude pulmonary edema appear at the same time.The diagnostic standard of ALI/ARDS in high altitude should not be the same as that in plain. [WT5HZ]