不同海拔高度多脏器功能障碍综合征诊断指标参数的对比观察

目的　动态观察多脏器功能障碍综合征 (MODS)相关指标参数的特异性及其与平原地区的差异。方法　将当日转入外科ICU的病例统一按课题组自行设计的调查表进行前瞻性多功能监测 ,对其中符合平原MODS评分诊断标准的 37例进行统计分析 ,并与本课题组同期调查的平原地区病例作对照 ,探索其间的异同点。结果　兰州地区MODS的APACHE -Ⅱ ,APACHE -Ⅲ ,PaO2 /FiO2 ,肌酐 (Cr)和GCS存活 /死亡评分比分别为 14 .5 7/2 4 .71,4 9.2 2 /93.2 9,138.19/139.5 6 ,137.78/2 5 3.96和 1.0 9/2 .4 3;P <0 .0 0 1,0 .0 0 1,0 .0 5 2 ,0 .14 7,0 .95 2 ,0 .0 0 1;西安地区分别为 18.2 3/2 2 .77,6 4 .0 8/85 .5 8,2 37.4 2 /179.92 ,186 .72 /35 0 .6 1和2 .2 0 /2 .76 ;P <0 .930 ,0 .0 0 1,0 .0 0 1,0 .0 0 2 ,0 .0 0 9;按Marshall标准兰州地区 37例中 ,2个脏器同时满 2分级占 8/37,满 3分级或以上 18/37,3个脏器满 2分级者 3/37,3分级或以上者 4 /37;单一脏器满 4分级 2 2 /37,37例中死亡 14例 ,死亡率为 37.8%。西安地区 2个脏器满 2分级占 18/6 6 ,3,4分级者占 2 2 /6 6 ,3个脏器满1、2分级者 2 1/6 6 ,3、4分级 11/6 6 ,4个脏器以上受损 11/6 6 ,6 6例中死亡 2 6例 ,死亡率为 39.4 %。以上结果提示高海拔地区除血气值

Comparative investigation of diagnostic parameters of MODS in Xi'an and Lanzhou

Objective: To study the speciality of MODS related parameters and the difference between those on plain and plateau. Methods:All the patients admitted to surgical ICU were registered according to the investigation form designed by the research group, and prospectively studied, of which 37 cases diagnosed as MODS based on criteria of MODS on plateau were analyzed . The results were compared with those on the plain studied in the meantime. Results:The ratios of living group to died group of APACHE- Ⅱ , APPACHE- Ⅲ, PaO2/FiO2, Cr, GCS were 14.57/24.71,49.22/93.29,138.19/139.56,137.78/253.96,1.09/2.43 respectively in Lanzhou area and 18.23/22.77,64.08/85.58,237.42/179.92,186.72/350.61,2.20/2.76 respectively in Xi'an area. According to Marshall's criteria among 37 cases in Lanzhou , the score of any two organs reached 2 grade in 8/37 cases and 3 grade or more in 18/37. The score of any three organs reached 2 grade in 3/37 cases and 3 grade or more in 4/37.The score of one organ reached 4 grade in 22/37. The death rate was 37.8 % (14/37). In Xi' an, the score of any two organs reached 2 grade in 18/66,and 3 grade or more in 22/66. The score of any three organs reached 2 grade in 21/66 and 3 grade or more in 11/66. More than four organs were damaged in 11/66 cases and the death rate was 39.4 % (26/66). The results revealed that in high altitude area , except that the values of blood- gas parameters were obviously lower than those on plain, other parameters were not more serious than those on plain . The death rate was similar between Lanzhou and Xi' an. Conclusions:The two groups of cases were analyzed according to the same model and the same diagnostic criteria. Because of different altitudes , the parameters showed different changing tendency. It was worth accumulating more cases for further study.