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目的 :研究中度高原地区 (15 17m)胸部手术前后多脏器功能指标的动态变化。方法 :选择拟行食管癌手术患者 2 0例 ,根据设计 ,对多脏器评分要求的 33项指标进行手术前后动态观察。通过对MODS多器官功能指标标准、APACHEⅡ评分系统、SIRS标准等进行统计学分析 ,对比手术前后各相关器官指标的变化和全身炎症 /应激反应的水平。结果 :血气指标变化幅度较大 ,PaO2 /FiO2 、AaDO2 与术前相比P <0 .0 1,术后第 1、3、5天符合SIRS 2～ 4项标准依次为 10 0 %、90 %、6 0 % ;术后第 1、2天全部达到ALI标准 ,术后第 1、3、5天达到ARDS血气指标的依次为 95 %、80 %、5 0 % ;按庐山会议标准多脏器功能损伤可满足 2～ 4个器官评分标准的第 1、3、5天依次为 9例 (45 % )、8例 (40 % )和 10例 (5 0 % ) ;血小板计数、谷草转氨酶、Na+ 、血糖等器官功能指标术后第 1、3、5天与术前相比P <0 .0 5 ,P <0 .0 1。结论 :中度高原地区胸部手术后对多个器官功能指标影响较大 ,所有病例均可满足SIRS和ALI、ARDS血气标准 ,半数病例达到轻度MODS标准。表明平原ARDS/MODS标准不适用于中度高原地区 ,有必要对诊断标准和海拔高度作出适合实际的界定。
Objective: To study the dynamic changes of multiple organ function indexes before and after thoracic operation in moderate plateau (15 17m). Methods: Twenty patients undergoing esophageal cancer surgery were selected. According to the design, 33 indexes required for multiple organ score were observed before and after operation. The MODS multi-organ function index standard, APACHEⅡscore system, SIRS standard were analyzed statistically to compare the change of relevant organ indexes before and after surgery and the level of systemic inflammation / stress response. Results: The changes of blood gas index were relatively large. PaO2 / FiO2 and AaDO2 were significantly different from those before operation (P <0.01). On the 1st, 3rd and 5th days after operation, the SIRS 2-4 criteria were 10%, 90% , 60%; all the patients achieved ALI standard on the 1st and 2nd day after operation, 95%, 80% and 50% of ARDS on the 1st, 3rd and 5th day after operation, respectively; 9 cases (45%), 8 cases (40%) and 10 cases (50%) on the 1st, 3rd, 5th day after functional injury were satisfied. The platelet count, aspartate aminotransferase, , Blood glucose and other indicators of organ function postoperative 1, 3, 5 days compared with preoperative P <0. 05, P <0. CONCLUSIONS: After multiple thoracic surgery, moderate to high altitude patients have a significant effect on multiple organ function indexes. All cases can meet the SIRS and ALI, ARDS blood gas standards, and half of the patients achieve mild MODS standards. It shows that plain ARDS / MODS standard is not suitable for medium plateau area, so it is necessary to make a proper definition of diagnostic criteria and altitude.