高原地区创伤和感染性急性呼吸窘迫综合征94例死亡原因分析

Posttraumatic or inflammatory acute respiratory distress syndrome on high altitude area: a retrospective analysis of 94 deaths due to ARDS/MOF

目的 探索高原地区急性呼吸窘迫综合征 (ARDS)发病特征、诊断标准。 方法 通过病案复习 ,对近 10年 2 3 2 5例院内死亡病例进行初筛 ,排除因恶性肿瘤、心脑血管病、慢性阻塞性肺疾病等所致慢性多器官衰竭 ,按照国内ARDS诊断标准 ,参照全身炎症反应综合征 /多器官功能障碍综合征 (SIRS/MODS)诊断模式 ( 1991年美国 )和欧美联席会议 1992年ARDS诊断标准进行死亡原因的回顾性分析。 结果 94例 ( 4 0 4 % )可重新确定为ARDS和肺外多器官损伤 ,包括肾、心、肝、胃肠等损害 79例 ,3 0 5个器官。单独肺衰只 15例。而原记录中只有 2 7例 ( 1 16% )曾诊为ARDS/MOF。 结论 结合实际拟定平原地区和高原地区诊断标准 ,实施创伤评分、血气监护与中西医结合治疗是降低病死率的重要措施。

Objection To determine the characteristic predictors of acute respiratory distress syndrome(ARDS) in the high altitude area of China. Methods According to the diagnostic criteria of ARDS, 2?325 cases were screened in the recent 10 years. Except malignant tumors, cardio cerebrovascular diseases, chronic obstructive pulmonary disease, and chronic multiple organ failure, the causes of death were analysed retrospectively. Results 94 cases (4.04%) were diagnosed as ARDS, but in the primary case reord, only 27 cases (1 16%) had been diagnosed as ARDS/MOF. Of the 94 ARDS patients, 79 complicated by extrapulmonary organ damage involving the kidney, heart, liver, gastro intestinal tract, and brain. A total of 305 organs were involved (average 3 24 organs each case). Lung failure only accounted for 15 cases. Conclusions The comination of the diagnostic criteria of ARDS for high altitude area and flate area, injury severity scale, blood gas monitoring,and integrated traditional Chinese medicine and western medicine may improve the prognosis of ARDS.