高原肺水肿不同治疗方案的疗效比较及其规范化治疗初步探讨

目的通过高原肺水肿（HAPE）不同治疗方案的疗效比较,对其规范化治疗进行初步探讨。方法将400例HAPE患者或随机分为A、B、C、D4组,A组给予吸氧、地塞米松、氨茶碱治疗,B组在A组基础上给予速尿治疗,C组在A组基础上给予硝苯地平治疗,D组在A组基础上给予左旋精氨酸治疗,并对4组的治疗效果及安全性（包括副作用及肝肾功能）进行综合评价,对其中安全、疗效显著的一组治疗方案进行规范化。结果 4种治疗方案对HAPE均具有明显的治疗作用,通过对其临床症状消失时间、体征消失时间、肺部X线阴影消失时间及住院时间比较,B组均显著低于A组、C组及D组（P〈0.01或P〈0.05）,A组、C组及D组之间相互比较无显著差异;4种治疗方案安全性比较,C组副作用发生率显著高于A组、B组及D组（P〈0.01）,A组、B组及D组之间副作用及4组肝肾功能之间比较均无显著差异。结论以吸氧、地塞米松、氨茶碱、速尿组成的HAPE治疗方案具有使用方便、高效、安全的特点,可作为HAPE规范化治疗方案加以推广。

Four therapeutic regimens for high altitude pulmonary edema: result comparison and preliminary study of standardized treatment

Objective To explore the standardized treatment of high altitude pulmonary edema （HAPE） through the comparison of therapeutic effects among different treatment plans. Methods 400 patients with HAPE were randomly divided into group A,B,C and D. Group A was given oxygen inhalation, dexamethasone and aminophylline; group B, C and D was given furosemide, nifedipine and l - arginine, respectively, besides the above treatments in group A. Then the therapeutic effects and safety including side effects ,hepatic and renal function were evaluated comprehensively. The relative safe and effective regimen was singled out for the standardization eventually. Results All of four regimens showed obvious effects on HAPE. The extinction time of clinical symptoms, physical signs and X - ray shades as well as hospital day were significantly shorter in group B than those in group A, C and D（ P 〈 0.05 or P 〈 0.01 ） , whereas there were no differences among other three groups. The incidence of side effects was significantly higher in group C than that in other three groups （ P 〈 0.01 ） , whereas neither significant differences of side effects were found among other three groups,nor significant differences in hepatic and renal function were found among the four groups. Conclusion The therapeutic regimen consisting of oxygen inhalation, dexamethasone, furosemide and aminophylline for HAPE is convenient, highly effective and safe. It can be used as the standard therapeutic regimen for HAPE.