急性高原反应症状及体征变化对高原脑水肿早期诊断意义的研究

目的观察和随访急进高原后疑似高原脑水肿者（HACE）的症状、体征变化，为制定HACE的早期诊断标准提供依据。方法对24200名急进高原人员进行筛查，对其中162例HACE疑似病例进行观察随访，总结急进高原1w内的症状、体征变化。结果在这些HACE疑似病例中，有36例最后确诊为HACE。HACE患者早期头痛、呕吐（症状评分≥4）以及呼吸困难、胸闷、咳嗽、紫绀发生率明显高于非HACE组（P〈0．05），且经休息及对症治疗后无缓解；HACE发病高峰为急性高原暴露24—72h。结论严重头痛、呕吐症状的出现与早期HACE发病密切相关，尤其当这些症状经15—24h单纯卧床、小流量吸氧及对症治疗后无明显缓解时，应警惕早期HACE的发生。

0Significance of changes of symptoms and physical signs in early diagnosis of high altitude cerebral edema

Objective To observe the changes of symptoms and physical signs in patients with suspected high altitude cerebral edema （HACE） after they arrived at high altitude rapidly and provide evidences for the early diagnosis of HACE. Methods 24 200 people who arrived at high altitude rapidly in recent two years were screened. Among them, 162 cases suspected highly as HACE were further observed,and the changes of their symptoms and physical signs were summarized just within a week after they arrived at high altitude. Results Among the suspected cases of HACE,36 cases were finally diagnosed as HACE. In HACE group, early headache and vomiting （scored over 4 points）as well as anhelation, chest distress, cough and cyanosis occurred more frequently than those in non - HACE group（P 〈 0.05 ）. Moreover, these symptoms and signs didn＇t alleviate even after rest and symptomatic treatment in HACE group. The nosogenic peak of HACE was 24 - 72 h after acute exposure to high altitude. Conclusion The occurrence of severe headache and vomiting may be closely related to the early onset of HACE, especially when these symptoms can not relieve in 15 - 24 h after simple rest, small flow oxygen inhalation and symptomatic treatment.