高海拔地区多脏器低氧损伤与重症急性高原病患者死亡的关系分析

The relationship analysis between the multi-organ hypoxia damage and the death in acute high altitude sickness severe sase

目的探讨高海拔地区多脏器低氧损伤与重症急性高原病患者死亡的关系。方法应用调查表对本院收治的3220例HACE与HAPE病例进行回顾，检出其中多器官功能障碍（MODS）及其死亡病例，分析其临床症状、体征、辅助检查等资料等对高海拔地区重症急性高原病患者临床死亡原因及其特点。结果8．7％急性高原病患者并发MODS（281／3220），其中治愈3185例，死亡35例，病死率为1．1％，死亡患者的各临床症状、阳性体征及辅助检查阳性发生率分别为2．86％～65．71％、2．86％～100％、14．29％～100％，死亡患者的MODS发生率为100％。281例并发MODS的患者（死亡35例，治愈246例）中死亡组MODS数、心脏功能障碍、脑功能障碍及肾功能障碍方面均显著高于治愈组（P〈0．05）。重症急性高原病患者死亡与MODS数呈正相关（r=0．3473，P〈0．01）。结论高海拔地区重症急性高原病患者的死亡与低氧对各脏器功能的损伤密切相关，心、脑、肾等重要脏器功能障碍是导致患者死亡的重要原因。

Objectives To analyze the relationship between the multi-organ hypoxia damage and the death of acute high altitude sickness severe case. Methods 3220 cases from 1956. 06 to 2005.06 in the hospital were reviewed by questionnaire and the cases in MODS or death were screened out. The cause of death and feature were analyzed by the data as clinical symptom, physical signs and auxiliary examination. Results 281 cases complicated by MODS （include 35 dead cases） were found out by review. The incidence with MODS is 8. 73%, and the death rate was 1.09%. The masculine incidence rate of the clinical symptom, physical signs and auxiliary examination in death were 2. 86% ~ 65.71%, 2. 86% ~ 100% and 14. 29% - 100%, respectively. The MODS incidence in dead cases was 100%. Compared with the curing group, the MODS number, cardiac functional disturbance, brain disorder and renal functional disturbance in the death group had a significantly high incidence rate in all the 281 cases with MODS（ P 〈0. 05 ）. With dependability analysis, there were a significantly direct correlation relationship between the death in the severe cases with acute high altitude sickness and the number of MODS（ r = 0. 3473, P 〈 0. 001 ）. Conclusion Hypoxia to the damage of multi-organ function play an important role in death of the severe ca- ses with acute high altitude sickness in high attitude area, and the functional disturbance of important organs as heart, brain and kidney is the most important cause to death.