高原环境下高原病再发的流行病学研究

目的了解在高原环境下住院高原病患者的预后。方法以医院(海拔3658m)40年间收治、并符合筛选标准的19118例住院病历为样本,随访1～15年,样本中以高原病首次住院为病例组,以非高原病首次住院者为对照组。随访两组高原病的发病情况,并进行临床流行病学的分析。结果(1)对照组的急性高原病发病率、总体发病率随观察年限延长而增加且呈正相关(r急=08259,P<001,r总=06815,P<005);急性高原病组和慢性高原病组的慢性高原病发病率随观察年限延长而减低,且呈负相关(r急1～7=08993,P<001;r慢1～9=09068,P<0001)。(2)病例组总体高原病逐年发病率在急性高原病组和慢性高原病组均显著高于对照组(P<001),RR=1129。(3)各型高原病发病率在急性高原病组和慢性高原病组均显著高于对照组(P<001)。急性高原病组以急性轻型高原病和高原肺水肿发病率最高,达1712%和2766%,RR=759;慢性高原病组以急性轻型高原病和Monges病发病率最高,达1284%和1119%,RR=531。结论高原病患者再发生高原病的风险显著增加,不适宜长期滞留高原地区。

Clinical retrospective investigation of prognosis of high altitude disease at high altitude

Objective: To study the prognosis of high altitude disease(HAD) at high altitude. Methods: 19 118 cases which were up to the screening standard were collected from all cases of inpatients in our hospital(above sea level 3658 m) from Feb. 1956 to Dec. 1995. Among these cases, 2098 cases suffered from HAD when they were first in hospital were adopted as the case group including acute HAD(AHAD) group and chronic HAD(CHAD) group, and the other 17020 cases suffered from non-HAD when they first in hospital were done as the control group. The prognosis of both groups was followed up for 1 to 15 years and the prevalence of HAD was analyzed. Results: 1. The morbidity of AHAD and total morbidity in the control group increased with followed-up prolongation, and there was a positive correlation between the morbidity and followed-up time(r AHAD =0.8259, p<0.01; r total =0.6815, p<0.05), but this tendency and correlation were not found in the case group. The morbidity of CHAD in AHAD group and CHAD group decreased gradually within observed period and was negatively correlated to the observed time(r AHAD =-0.8993, p<0.01; r CHAD =-0.9068, p<0.01). 2. The morbidity year-by-year and accumulative morbidity of HAD in case group was higher than that of the control group(p<0.01). 3. The morbidity of all HAD types in either AHAD group or CHAD group was higher than that of the control(p<0.01). Among AHAD group, the morbidities of acute benign high altitude disease and high altitude pulmonary edema were the highest and reached to 17.12% and 27.66%, respectively. Among CHAD group, the morbidities of acute benign high altitude disease and Monge's disease were the highest, and reached to 12.84% and 11.19%, respectively. Conclusion: People with a HAD history are of higher risk of reoccurrence of HAD and they are not suitable to live for a long time at high altitude.