高原重度创伤失血性休克并发症的特点及预防

Features and prevention of complications after severe traumatic hemorrhagic shock in plateau

目的探讨高原（海拔3658m）不同人群重度创伤失血性休克（ traumatic hemorrhag-ic shock, THS）患者并发症的特点及预防措施。方法回顾性分析1976年10月-1990年10月采取传统复苏方法（传统复苏组，103例）和1991年10月-2012年10月采用综合治疗方法治疗（综合治疗组，488例）的世居高原藏族、移居高原汉族（移居高原3个月以上）和急进高原汉族（进入高原1周以内）重度THS患者共591例，并对结果进行比较。结果传统复苏组世居高原藏族患者并发症主要有应激性溃疡2例，肺水肿1例，MODS3例，死亡3例；移居高原汉族患者并发症主要有应激性溃疡9例，肺水肿8例，ARDS3例，脑水肿1例，急性肾功能衰竭3例，弥散性血管内凝血（disseminatedintravaseularcoagulation，DIC）2例，MODS13例，死亡11例；急进高原汉族患者并发症主要有应激性溃疡5例，肺水肿4例，ARDS4例，脑水肿2例，急性肾功能衰竭3例，DIC2例，MODS6例，死亡4例。综合治疗组世居高原藏族患者、移居高原汉族患者、急进高原汉族患者的并发症发生率和死亡率均显著低于传统复苏组相应人群患者。结论（1）采用传统复苏方法的高原重度THS患者并发症多、发生早、发生率高、进展快、程度重、死亡率高；而且急进高原汉族重于移居高原汉族和世居藏族。（2）采取综合治疗方法可显著降低患者并发症的发生率和死亡率。（3）急进高原汉族患者对综合治疗方法的依赖程度大于移居高原汉族患者和世居藏族患者。

Objective To investigate the features and prevention measures of complications sec- ondary to severe traumatic hemorrhagic shock （THS） of different crowds in plateau （3 658 meters above the sea level）. Methods A retrospective study was conducted on 591 severe THS patients undergone traditional resuscitation （ traditional resuscitation group, n = 103 ） from October 1976 to October 1990 and integrated treatment （ integrated treatment group, n = 488 ） from October 1991 to October 2012. The pa- tients included native Tibetans, Han immigrants in plateau （ ≥ 3 months ） and Han people who entered plateau rapidly （ 〈 7 days）. Outcome of the two treatments was compared. Results With regard to the traditional resuscitation group, native Tibetans sustained the main complications including stress ulcer （ n = 2 ） , pulmonary edema （ n = 1 ） , MODS （ n = 3 ） and death （ n = 3 ） ; Hart immigrants in plateau sus- tained the main complications including stress ulcer （ n = 9 ）, pulmonary edema （ n = 8 ） , ARDS （ n = 3 ）, cerebral edema （ n = 1 ）, acute renal failure （ n = 3 ）, disseminated intravascular coagulation （DIC） （n =2）, nODS （n = 13） and death （n = 11 ）; Han people who entered plateau rapidly sustained the main complications including stress ulcer （ n = 5 ） , pulmonary edema （ n = 4） , ARDS （ n = 4 ） , cerebral edema （ n = 2）, acute renal failure （ n = 3 ）, DIC （ n = 2）, nODS （ n = 6） and death （ n = 4）. Whereas in contrast to the relevant patient crowds in the traditional resuscitation group, the native Tibetans, Han immigrants in plateau and Han people who entered plateau rapidly presented significant reduction of com- plication rate and mortality rate in the integrated treatment group. Conclusions （1） Traditional resus- citation for severe THS patients in plateau results in much more complications with quick occurrence, high incidence, rapid progression, high severity and high mortality. Moreover, the complications aremore severe in Han people who entered plateau rapidly than in the Han immigrants in plateau and native Tibetans. （2） The incidence of complications and death rate are significantly reduced after integrated treatment. （3） Han people who entered plateau rapidly present larger dependence on integrated treatment than the Han immigrants in plateau and native Tibetans.