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目的探讨高原过度通气试验诊断早期急性高原肺水肿(HAPE)的意义。方法从急进高原的某部官兵中筛选出40例可疑早期高原肺水肿受试者,按照1︰1比例入组40例急性高原反应的受试者。对上述两组受试者在过度通气试验前后进行经皮SaO_2检测,并进行肺部高分辨CT(HRCT)检测,以评估受试者是否发生早期高原肺水肿。对疑似早期HAPE受试者中过度通气试验阳性的12例受试者在抗高原肺水肿治疗前后,以及阴性对照组(过度通气试验和HRCT双阴性)26例受试者给予吸氧后进行经皮SaO_2检测。结果疑似早期HAPE组和高原反应组过度通气试验阳性分别有12例(阳性率30%)和1例(阳性率2.5%),疑似早期HAPE组出现过度通气试验的阳性率显著高于高原反应组(P<0.05);对两组受试者进行胸部HRCT检查,疑似早期HAPE组有11例诊断为早期HAPE,出现HAPE的阳性率显著高于高原反应组(P<0.05)。过度通气试验和HRCT对早期HAPE的检出率无显著差异(P=0.90),过度通气试验诊断HAPE的敏感性为81.8%,特异性为89.6%。在平静呼吸时和吸氧后,过度通气试验阳性受试者治疗前的SaO_2均明显低于阴性对照组和过度通气试验阳性受试者治疗后的水平(P<0.05)。结论高原过度通气试验是一种诊断高原肺水肿非常有用而又简便的工具,但其需要进一步优化和进行大规模的验证。
Objective To investigate the significance of plateau hyperventilation in the diagnosis of early acute pulmonary hypertension (HAPE). Methods Forty patients with suspected early altitude pulmonary edema were screened from a certain number of soldiers in the steep plateau. Forty patients with acute altitude sickness were enrolled according to the ratio of 1: 1. The above two groups of subjects were tested for percutaneous SaO 2 before and after the hyperventilation test and pulmonary high resolution CT (HRCT) was performed to evaluate whether the subjects had early high altitude pulmonary edema. Twenty-six subjects who were positive for hyperventilation in suspected early-stage HAPE subjects were given oxygen before and after anti-plateau pulmonary edema treatment, and in the negative control group (hyperventilation test and HRCT double-negative) Skin SaO_2 test. Results There were 12 positive cases (30% positive) and 1 case (positive rate 2.5%) in the early stage of HAPE and altitude sickness test. The positive rate of hyperventilation in the early HAPE group was significantly higher than that in the high altitude sick group (P <0.05). The HRCT examination of chest and chest in both groups was performed. Eleven cases of early HAPE were diagnosed as early stage HAPE, and the positive rate of HAPE was significantly higher than that of the plateau group (P <0.05). There was no significant difference in the detection rate of early HAPE between hyperventilation test and HRCT (P = 0.90). The sensitivity and specificity of hyperventilation test for diagnosing HAPE were 81.8% and 89.6% respectively. The levels of SaO_2 in subjects with positive hyperventilation were significantly lower than those in negative control and hyperventilation-positive subjects (P <0.05) after both breathing and oxygen inhalation. Conclusion The hyperventilation test is a useful and easy tool to diagnose high altitude pulmonary edema, but it needs further optimization and large-scale verification.