急性重症高原病患者胃肠功能紊乱与多器官功能障碍综合征的关系

目的 通过病历回顾性分析和前瞻性研究的方法 ,探讨急性重症高原病患者胃肠功能紊乱与高原多器官功能障碍综合征(MODS)的关系.方法 ①回顾性调查1958年6月-2007年6月50年西藏军区总医院住院治疗的3 184例急性重症高原病患者的临床资料,重点对其胃肠功能紊乱与高原MODS之间的关系进行统计分析.②选择10例急性重症高原病患者作为观察组进行前瞻性研究,采用纤维胃镜检查胃和十二指肠黏膜,然后口服谷氨酰胺(Gln)颗粒剂30 g/d,共3 d;以10例健康体检自愿者为对照组,给予相同的处理方法 .两组于用药前后分别检测血清二胺氧化酶(DAO)、丙二醛(MDA)、内毒素水平及尿乳果糖/甘露醇(L/M)比值.结果 ①3 184例急性重症高原病患者中胃肠功能紊乱者占49.8%,其中1.5%有黑便,1.0%有大便潜血;83例合并MODS患者中有18例(占21.7%)伴严重胃肠功能紊乱,胃肠功能障碍综合评分为5.5分.②急性重症高原病患者纤维胃镜检查见胃肠黏膜广泛水肿和小灶性出血,胃窦和胃底部见点片状糜烂.观察组用药前血清DAO、MDA、内毒素均显著高于对照组(P均＜0.01),用药3 d后血清DAO、MDA、内毒素均较用药前显著降低(P＜0.05或P＜0.01).观察组用药前尿L/M比值显著高于对照组(150.69±19.91比117.91±17.78,P＜0.01),用药3 d后尿L/M比值降至129.37±19.75(P＜0.05);对照组则无明显变化.结论 胃肠功能紊乱是急性重症高原病诱发MODS一个不可忽视的原因之一.

Gastrointestinal dysfunction in acute severe mountain sickness and its relation with multiple organ dysfunction syndrome

Objective To investigate the relationship between gastrointestinal dysfunction(GD)and multiple organ dysfunction syndrome(MODS)in acute severe mountain sickness(ASMS),including high altitude pulmonary edema(HAPE),and high altitude cerebral edema(HACE),by a retrospective study of medical records and prospective study of hospitalized patients.Methods In retrospective study,the clinical data of 3 184 inpatients of General Hospital of Tibetan Military Command suffering from ASMS in the past 50 years(from June,1958 to June,2007)were collected.Statistical analysis was performed to study the relationship between GD and MODS in these patients.For the prospective study,10 admitted patients of ASMS were included.Gastroscopic examination was performed for the ASMS patients,and gastric and duodenal mucosa was scrutinized.At the same time,30 g of glutamine(Gin)capsule was orally ingested each day for 3 days after the first day of admission.Ten healthy volunteers were included in the control group,and received the same treatment.The levels of serum diamine oxidase(DAO),malonic dialdehyde (MDA),endotoxin and lactulose/mannitol(L/M)ratio were detected before and after treatment in two groups.Results First,49.8%of the patients with ASMS were complicated with GD,with 1.5%of fairy stool,and 1.0%with occult blood in stool.In 83 cases of ASMS complicated with MODS,21.7%(18 cases)appeared GD,and the score of GD was 5.5 in the total score of all organ injury.Second, endoscopic examination showed extensive edema and localized hemorrhage in gastrointestinal mucous membrane,with dotted and patched erosion in gastric antrum and fundus.The pre-treatment DAO,MDA,and endotoxin were higher in the observation group than those in the control group(all P＜0.01).After 3 days of Gln capsule treatment,DAO,MDA,and endotoxin were significantly decreased in the observation group(P＜0.05 or P＜0.01).The pre-treatment L/M ratio in observation group was significantly higher than that in healthy control group(150.69±19.91 vs.117.91±17.78,P＜0.01).The L/M ratio was significantly decreased after the treatment,as it decreased to 129.37±19.75(P＜0.05).However,no significant change in the healthy control group was observed.Conclusion GD plays a major role in the pathogenesis of MODS in ASMS patients.