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目的 :评估急性高原病 (AHD)合并多脏器功能障碍综合征 (MODS)的诊断标准和依据。方法 :参照平原MODS诊断标准对高原现场救护和转院的AHD病例进行回顾性调查 ,锁定原发病因为高原脑水肿 (HACE)、高原肺水肿 (HAPE)为调查对象 ,重点收集与心、肺、脑、肾、肝、血液、肠、代谢八个脏器相关的功能指标 ,按庐山 (1995) ,Marshall(1995) ,兰州 (1999)有关MODS/ARDS评分诊断对各脏器损害程度进行综合评分。结果 :9例均在急进高原 450 0～ 470 0m后急性发病 ,发病至诊治时间平均≥ 2 0 .6h。全组均在发生AHD后进行现场救护 ,其中 6例无效转入上一级医院 5～ 9d死于MODS。 9例中原发病因为HACE 5例 ,HAPE4例。可明确脏器损害者共有 44个脏器 ,平均每例 4.9个脏器受损 ;其中达到脏器衰竭标准共有 3 4个脏器 ,平均为3 .8个脏器衰竭。 9例中 5例进行APACHE -Ⅱ评分 ,分值最低为 15分 ,最高 2 7分 ,平均 2 1.7分。结论 :①HACE或HAPE不是单一脏器受损 ,而是多脏器受损 ,MODS是导致死亡的最危险因素 ;②及时有效地现场救治可能是阻断病情发展、逆转危险结局的重要手段
Objective: To evaluate the diagnostic criteria and basis of acute mountain sickness (AHD) complicated with multiple organ dysfunction syndrome (MODS). Methods: According to plain MODS diagnostic criteria, AHD cases of ambulance and referral at plateau site were retrospectively investigated. The primary causes were HACE and HAPE, According to Lushan (1995), Marshall (1995) and Lanzhou (1999), the comprehensive evaluation of MODS / ARDS score on the degree of damage of various organs was made according to the functional indexes of brain, kidney, liver, blood, . Results: All the 9 cases were acutely exited after 450 0 ~ 470 0 m in the plateau. The average time to diagnosis and treatment was ≥ 20.6 hours. The whole group were on-site ambulance after the occurrence of AHD, of which 6 cases were ineffective transferred to the upper hospital 5 to 9d died of MODS. 9 cases of central origin because of HACE in 5 cases, HAPE4 cases. A total of 44 organs can be identified as organ damage, with an average of 4.9 organ damage per case. In total, 34 organs have reached the standard of organ failure, with an average of 3.8 organ failure. Five of the 9 patients underwent APACHE-II scores, with a minimum of 15 points and a maximum of 27 points, an average of 2 1.7 points. Conclusions: ①HACE or HAPE is not a single organ damage, but multiple organ damage, MODS is the most dangerous factor leading to death; ② timely and effective on-site treatment may be blocking the progression of the disease, an important means to reverse the dangerous outcome