高原地区ARDS/MODS早期诊断治疗的经验体会

Diagnosis and treatment of critical patient with H-ARDS/MODS at high altitude

目的：探讨高原地区ARDS／MODS（H-ARDS／MODS）的早期诊断和治疗。方法：将过去14年入住我院ICU的170例H-ARDS／MODS病例按建立诊断标准的时间分为建标前组（A组，1994-01～1999-12，n=85）、建标后组（B组，2000-01～2007-12，n=85）。两组均按H-ARDS／MODS标准对比分析多器官功能指标的变化及其对结局的影响。结果：两组在原发病因、年龄、病情基础、APACHE评分大体均衡条件下，A组发病至入ICU时间、上机时间明显晚于B组（P〈0．01）。A组多脏器损伤评分为13．6分，死亡27例，病死率为31．8％；B组多脏器损伤评分为11．9分；死亡14例，病死率为16．5％。结论：以H-MODS评分诊断为依据，准确把握早期诊断治疗的切入点进行早期机械通气是降低病死率的关键。

Objective： To research the early diagnosis and treatment methods of critical patients complicated with acute respiratory distress syndrome and multiorgan dysfunction syndrome at high altitude （ H - ARDS/MODS）. Methods ： According to the creation time of the diagnosis criteria of H - ARDS/MODS, 170 cases were divided into two groups ： group A （from January 1994 to January 1999, n = 85 ） , and group B （from January 2000 to December 2007, n = 85）. According to the same diagnostic criteria of H - ARDS/MODS, a comparison analysis were made based on the muhiorgan function score index, treatment interferes as well as the influence to the result. Results： There was no significant difference statistically in conventional clinicopathologic data between the two groups, including etiology, age and grade of APACHE. The patients in group A were treated later than those in group B （P 〈0.01 ）. The total score of multiorgan injuries and mortality rates in group A and B were 13.6 vs 11.9 and 31.8% vs 16.5% , respectively. Conclusion： Based on the diagnostic and scoring criterion at high altitude, early diagnosis and mechanical ventilation may be the key procedure for decreasing morbidity and mortality for patieuts with H - ARDS/MODS.