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目的 :研究高海拔 (2 2 6 0 m )地区严重创伤引起的急性呼吸窘迫综合征 (ARDS)的诊断标准。方法 :观察连续收治的 90例高海拔地区 ARDS的临床特征、动脉血气变化、X线胸片改变 ;并与平原 ARDS的诊断标准比较。结果 :高海拔地区创伤性 ARDS患者临床特征是 :1严重呼吸困难或窘迫 ,本组呼吸频率 38～74次 / min,平均 41次 / m in。 2严重紫绀 ,本组血氧饱和度 0 .2 3～ 0 .5 7(平均 0 .34)。 3严重低氧血症 ,Pa O2 2 .2～ 6 .0 k Pa(平均 3.6 k Pa,1k Pa=7.5 mm Hg)。4早期呼碱 ,Pa CO2 <1.5 k Pa,晚期呼酸 ,Pa CO2 >10 .0 k Pa。5氧合指数 (Pa O2 / Fi O2 ) 10 .6～ 2 5 .0 k Pa(平均 13.7k Pa)。6肺泡动脉氧压差 (PA a O2 ) 6 0～ 6 3k Pa(平均 5 8k Pa)。7双肺闻及大量的湿性口罗音和广泛性支气管哮鸣音。 8X线胸片示双肺大片状或云雾状渗出阴影。本组死亡2 3例 ,病死率 2 5 .6 %。结论 :高海拔地区 ARDS患者临床上有它特殊的症状体征 ,特殊的动脉血气变化与 X线胸片的改变。与平原 ARDS相比 ,差异显著。因此 ,建议应尽快建立合理实用的高海拔 ARDS诊断标准
Objective: To study the diagnostic criteria of acute respiratory distress syndrome (ARDS) caused by severe trauma at high altitude (2260 m). Methods: The clinical features, changes of arterial blood gas and X-ray of ARDS in 90 consecutive high-altitude areas were observed and compared with the diagnostic criteria of plain ARDS. Results: The clinical features of patients with traumatic ARDS at high altitude were: 1 Severe dyspnea or distress, the respiratory rate was 38-74 times / min in this group with an average of 41 times / min. 2 Serious cyanosis, the group of oxygen saturation 0. 23 ~ 0. 57 (average 0.34). 3 Severe hypoxemia, Pa O2 2 .2 ~ 6 .0 kPa (average 3.6 kPa, 1k Pa = 7.5 mm Hg). 4 Early exhalation, PaCO2 <1.5 k Pa, late sour, Pa CO2> 10 .0 k Pa. 5 Oxygenation index (Pa O2 / Fi O2) 10.6 ~ 2.5 5 .0 Pa (average 13.7k Pa). 6 Pulmonary arterial oxygen pressure difference (Pa a O2) 6 0 ~ 6 3k Pa (average 5 8k Pa). 7 Double lung smears a lot of wet mouth rales and extensive bronchial wheeze. 8X line chest X-ray showed large flakes or cloud-like oozing shadows. The group died of 23 cases, the mortality rate 25.6%. Conclusion: ARDS patients in high altitude clinically have its special symptoms and signs, special arterial blood gas changes and X-ray changes. Compared with plain ARDS, the difference is significant. Therefore, it is suggested that a reasonable and practical high altitude diagnostic criteria for ARDS should be established as soon as possible