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目的 :探讨不同海拔梯度创伤性急性肺损伤ALI/ARDS发病特征和早期诊治。方法 :按AIS -ISS记分标准将院内记分在2 0分或以上多发伤病例分为 15 0 0m(兰州 )梯度组A组和 2 2 6 0～ 2 40 0m(西宁和玉门 )梯度组B组 ,观察两组自受伤～院内救护至发生ALI/ARDS的时间、发病特点、血气变化。结果 :在伤情相近 ,原发伤处理相近的条件下 ,B组ARDS临床过程、发病机率及其监测指标显著早于、重于、多于A组 ,P <0 .0 1或P <0 .0 5 ,但死亡率两组相近。结论 :高海拔区创伤性ALI/ARDS可能具有缺氧 /创伤双重打击因素和高压性 /高渗性混合性肺水肿双重病生性质。诊断标准应异于平原。
Objective: To investigate the characteristics and early diagnosis and treatment of ALI / ARDS in patients with traumatic acute lung injury at different altitudes. Methods: According to the criteria of AIS-ISS, the patients with multi-injury score of 20 or more in the hospital were divided into Group A of 15 0m (Lanzhou) gradient group and Group B of 2620 ~ 240m (Xining and Yumen) gradient group B Group, from the injured ~ hospitalized to the occurrence of ALI / ARDS time, incidence characteristics, blood gas changes. Results: The clinical course, the incidence of ARDS and the monitoring indicators of ARDS in group B were significantly earlier than, heavier than, and more than those in group A, with similar injuries and similar primary injuries (P <0.01 or P <0.01) .0 5, but the mortality rates are similar between the two groups. CONCLUSIONS: Traumatic ALI / ARDS in high altitude may have dual hypoxia / trauma and hypertensive / hypertonic pulmonary edema. Diagnostic criteria should be different from plain.