不同海拔梯度急性呼吸窘迫综合征诊断标准的探讨

目的 :探讨高海拔地区急性呼吸窘迫综合征 (H -ARDS)诊断标准。方法 :设平原ARDS报告资料为对照组 ,对海拔≥15 17～ <2 0 0 0m(兰州 ,昆明 ) ,≥ 2 0 0 0～ <2 5 0 0m(西宁 ,酒泉 ,玉门 ) ,≥ 2 5 0 0～ 36 5 8m(格尔木 ,拉萨 )报告的总计为 5 0 0例ARDS相关资料进行比较 ,验证《H -ARDS诊断标准试行草案兰州会议 1999》临床使用的可行性。结果 :PaO2 /FiO2 平原组 185～ 2 2 6mmHg;≥ 15 17～ <2 0 0 0m组 40～ 2 86 (15 0 .2 )mmHg ;≥ 2 0 0 0～ <2 5 0 0m组 98～ 10 5 (10 3.8)mmHg ;≥ 2 5 0 0～ 36 5 8m组≤ 10 4mmHg。三组高海拔地区ARDS病例的PaO2 /FiO2 值均明显低于平原地区参考值 ,海拔愈高差异愈明显。结论 :高原ARDS病例PaO2 /FiO2 与平原差异显著 ,表明诊断高原ARDS需要与平原不同的标准。与《兰州会议标准草案》所制订的诊断标准相比 ,本文ARDS病例PaO2 /FiO2 均值较低 ,提示原诊断标准尚不够严格

Evaluation of diagnostic criteria of acute respiratory distress syndrome at different altitude

Objective:To evaluate the diagnostic criteria of acute respiratory distress syndrome at high altitude (H-ARDS).Methods:500 cases of H-ARDS were divided into three groups: (A) 1 517 - 2 000 m group (Lanzhou and Kunming), (B) 2 000 - 2 500 m group (Xining, Jiuquan and Yumen), (C) 2 500 - 3 658 m group (Geermu and Lasa). PaO 2/FiO 2 in these three groups were compared with that of the flatland (Shanghai)and the reference value established by the "Diagnostic Criteria of ALI/ARDS at High Altitude, Lanzhou, 1999" to investigate the clinical feasibility of the criteria.Results:The values of PaO 2/FiO 2 were 40-286 mmHg (150.2 mmHg), 29-195 mmHg (103.8 mmHg) and 81-108 mmHg (104 mmHg) respectively in A, B and C groups, which were lower than that of flatland (185-226 mmHg).Conclusion:The differences between PaO 2/FiO 2 of ARDS at high altitudes and at plain suggest that diagnostic criteria of ALI/ARDS at High Altitudes should be different from that of the plain. As to the PaO 2/FiO 2 criteria in the "Diagnostic Criteria of ALI/ARDS at High Altitude, Lanzhou, 1999", we believe that the criteria value for ALI/ARDS should be lower.