高原肺心病极重度呼吸衰竭与多器官衰竭及救治

MULTIPLE ORGAN FAILURE AND EMERGENCY TREATMENT IN PATIENT OF HIGH ALTITUDE CHRONIC COR PULMONALE WITH SEVERE RESPIRATORY FAILURE

对６２例ＰａＯ＿２＜４．０ｋＰａ的高原肺心病急性发作期并发多器官衰竭患者，采用了抗感染、通畅气道、利尿、强心、吸入２９～３５％氧、呼吸兴奋剂、糖皮质激素、降低血粘度等救治，救治成功率８８．７％，病死率１１．３％。认为其虽有极重庆呼衰和多器官衰竭，但若救治２４小时后ＰａＯ＿２能提高到５．３３ｋＰａ以上，则基本可救治成功，若仍低于４．０ｋＰａ，则应尽早行机械通气，并对救治中几个特殊问题进行了讨论。

ultiple organ failure(MOF)and the result of emergency treatment in 62 patients(38male, 24female, age 59.2±6.8years) of high altitude chronic cor pulmonale(HACCP)(2 260-3200m abovesea level) with severe respiraory failure(PaO_2<4. 0 kPa) were reported. Methods :①The availableantibiotics , expectorants, bronchedilators , diuretics and cardia stimullant were administered.②All thepatients continuously breathed 29～35%oxygan and received the nikethamid i.v. infusion once or twotimes daily for 2～3days.③The patients with blood hyperviscosity received low molecular dextran,heparin, compound red sage rcot, regitine i.v. infusion once time daily for 10days.④All the patientsreceived dexamethasone or hydrocortisone i.v. infusion once time daily for 3～5days.The results wereas follovvs: All the patients complicated MOF,among them 43 cases(69.4%)revealed2 organs failure(OF),10 cases(16.1%)revealed 3 OF(1cases died)and 9 cases(14.5%)revealed 4 or more than4 OF(6 cases died).Of them, 55 cases(88.7%)recovered and 7 cases died with total mortality rateof 11.3%。 The results showed that complication rate of MOF in patients of HACCP with PaO_2<4.0kPa was very high.The overwhelming majority of the patients vvith 2～3OF was recovered by ef-fective combined treatment. After treatment , however , PaO_2<4. 0 kPa in the patients with 4 or morethan 4 OFindicated the occurence of death.