急性重症高原病规范化治疗方案的建立与应用

The Establishment and Application of Standardized program of Treatment for Acute Severe type High Altitude Disease

目的:建立急性重症高原病(Acute severe high altitude disease,ASHAD)规范化的治疗方案,并评价其临床疗效。方法:自1992年开始研究急性重症高原病的临床治疗方案,于2000年正式确立标准化的治疗方案,并将此方案广泛运用于临床,其中对2000年1月—2002年12月3年间收治于青海省人民医院和格尔木市人民医院的ASHAD确诊患者203例,按随机数字表法分为标准化方案治疗组(125例)和一般疗法治疗对照组(78例),按照轻、中、重、极重分期和分型,比较两种治疗方案组的住院时间、总治愈率及不同分型患者的病死率。结果:标准化方案组的平均住院天数较一般疗法组缩短1.66天[(5.28±3.17)天vs(6.94±4.05)天,P<0.01],总治愈率提高了7.06%(96.80%vs 89.74%,P<0.05),重型及极重型患者的病死率分别下降了5.59%和31.15%,总病死率明显下降(3.20%vs10.26%,P<0.01)。结论:该方案对ASHAD根据病情分为四期和四型,即一期(轻型)、二期(中型)、三期(重型)、四期(极重型);并根据不同分期和分型制定治疗方案,极重型者收住ICU治疗,突出重症医学在高原医学中的作用;通过该规范化治疗方案能有效降低重型和极重型ASHAD患者病死率;将该方案广泛运用在青藏铁路建设和玉树地震及灾后重建高原建设人员中,提高了治疗的有效性,降低了治疗风险与治疗成本,有效地保障了高原建设人群的健康和生命。

Objective：To establish standardized program of treatment for Acute Severe type High Altitude Disease（ ASTHAD）,and evaluate its clinical efficacy. Method：The study of clinical treatment scheme for severe acute altitude disease,started in 1992,established formally in 2000. And then it has been widely used in clinical.During the three years from January 1,2001 to December 31,2002,there were 203 patients diagnosed as ASHAD in Germud People＇s Hospital and Qinghai Provincial People ＇s Hospital in Qinghai province. They were randomly assigned to standardized treatment group（ n = 125） and common treatment control group（ n = 78）,and divided into four stages according to mild,medium,severe,fatal. And then comparing the hospital stays,total recovery rate and mortality between the two groups. Results： The hospital stay decreased 1. 66 days in the standardized treatment group compared with common treatment control group [（5. 28 ＋ 3. 17） vs（6. 94 ＋ 4. 05）,（ P〈0. 01）],the cure rate increased 7. 06%（96. 80% vs 89. 74%,P〈0. 05）,mortality of severe and fatal also decreased 5. 59% and31. 15%,respectively. The mortality of patients in standardized treatment group decreased（3. 20% vs 10. 26%,P〈0. 01）. Conclusion：The scheme of ASHAD according to the disease is divided into four periods and four types,namely the first period（ mild）,second period（ medium）,third period（ severe）,forth period（ fatal）; According to the different stages and types,a treatment plan can be established,and fatal patients were admitted to intensive care unit（ ICU）. The standardized treatment can effectively reduce the mortality of acute severe patients with ASHAD; the scheme is widely used in the construction of the Qinghai Tibet railway and the Yushu earthquake area and post disaster reconstruction improving the effectiveness of the treatment,reducing the risk and cost of the treatment,effectively protecting the health and life of the people who constructing the plateau area.