单中心高原肺水肿重要临床表型规律的研究

A Single Center Study on Main Clinical Phenotypes of High Altitude Pulmonary Edema

目的：通过分析较大样本高原肺水肿的临床表型特点规律,为早期诊断及防治提供依据。方法：采用现况调查研究,对2009年4月—2011年6月连续入院确诊为高原肺水肿患者的基本特征、发病时间规律、累及部位及严重程度等进行临床流行病学研究。结果：1共入选300例汉族高原肺水肿患者,其中男232例,女68例;平均年龄（38.57±13.85）岁;2发病时间从平原到达高海拔地区拉萨（海拔3 658m）后计算,12小时内发病的占43.67%,（12~24）小时内发病的占26.33%,（24~48）小时内发病的占17.00%,（48~72）小时内发病的占9.00%,（72~96）小时内发病的占2.67%,96小时后发病的仅占1.33%;3高原肺水肿患者经皮指式血氧饱和度平均水平为65.14%±12.75%,95%可信区间为62.14%~64.89%。Sa O265%以下者（含65%）占50.34%,Sa O275%以下者占78.67%,Sa O285%以下者占94.00%;4肺部累及部位情况,累及双肺者占83.00%,单纯右肺者占15.33%,单纯左肺者仅占1.67%。结论：高原肺水肿患者以青壮年为主,男性多见,发病时间早,并以进入高原前三天为高峰,临床缺氧程度严重,因此,早期发现、早期诊断和早期治疗仍然为高原肺水肿防治的关键。

Objective： To investigate the main clinical phenotypes of high altitude pulmonary edema（ HAPE） in hospitalized patients to provide a basis for its prevention and treatment. Methods ： A cross- sectional survey was conducted on the clinical data in hospitalized patients with HAPE from April of 2009 to June of 2011. The patient’s main clinical phenotypes such as the time of onset,oxygen saturation（ Sa O2）,the position of HAPE on X ray were analyzed. Results： A total of 300 consecutive patients with HAPE were studied including 232 cases of males and 68 females with mean age of 38. 57 ± 13. 85 years. Forty three point sixty seven percent of total patients appeared their symptom with in 12 hours after arrived at Lhasa city with altitude of 3 657 meters above sea level. 26. 33% between 12 to 24 hours,17. 00% between 24 to 48 hours,9. 00% between 48 to 72 hours,2. 67% between 72 to 96 hours,only 1. 33% more than 96 hours. The mean Sa O2 of HAPE was 65. 14 ± 12. 75% with 95 % confidence interval 62. 14% ~ 64. 89%,the percentage of Sa O2 lower than 65% was 50. 34%,lower than 75 was 78. 67%,lower than 85 was 94%. The X ray showed 83. 00% of patients showed pulmonary imaging changes on both lung,15. 33% on the right lung,only 1. 67% on left. Conclusion： The most of the patients with HAPE were young adults,and the ratio of male higher than that of female. The time of onset became early and majority was with in first three days after arrived at high altitude. In brief,Early discovery and diagnosis is significantly important for improve prognosis of patients with HAPE.