不同海拔区域高原肺水肿发病情况及危险因素分析

Incidence and risk factors of high altitude pulmonary edema of different altitudes

目的分析急进高原后发生高原肺水肿(HAPE)与不同海拔区域的相关性,探讨在不同海拔区域下HAPE的发病情况及危险因素。方法回顾分析于本院就诊的急性高原病患者(包括高原肺水肿)87例,将急进高原后发生HAPE患者根据不同海拔区域发病分为两组(A组:2500~3500米,B组:3501~4500米),其中A组49例,B组38例。应用t检验和χ^(2)检验分析在不同高海拔区域发生HAPE患者的发病情况(血氧饱和度、呼吸、心率、体温、白细胞数、影像学改变,肺部体征以及下降到同海拔区域后的转归),二元Logistic回归分析发生HAPE的相关危险因素。结果87例纳入对象中,B组出现HAPE人员占92.1%,A组出现HAPE人员占26.5%。B组患者入院时血氧饱和度较A组患者有显著降低,白细胞总数、心率、呼吸较A组患者显著增高,B组患者肺部阳性体征(湿罗音)、影像学阳性(双肺斑片状阴影)发生率亦高于A组(P<0.05),B组患者体温较A组患者体温升高,但两组间无统计学差异(P>0.05)。Logistic回归分析显示海拔高度、性别、基础疾病、久居地均为HAPE发生的独立危险因素,其中有基础疾病者OR值最高(OR=17.667)。结论在不同海拔区域下HAPE的发病情况存在显著差异,海拔高度、性别、久居地、基础疾病等因素对HAPE有显著影响,尤其是有基础疾病者风险更高,上述研究将为降低进入高原官兵、游客及务工人员在高海拔区域发生HAPE提供理论依据。

Objective To analyze the pertinence between HAPE and the various altitude areas after a rapid land on,and investigate the related pathogenic situation and risk factors.Methods Eighty-seven patients with acute altitude disease(including high altitude pulmonary edema)in our hospital were retrospectively analyzed.Patients with HAPE after rapid elevation were divided into two groups according to different altitude areas(group A:2500-3500 m,group B:3501-4500 m),including 49 cases in group A and 38 cases in group B.t test andχ^(2) test were used to analyze the incidence of HAPE patients at different high altitudes(oxygen saturation,respiration,heart rate,body temperature,white blood cell count,imaging changes,pulmonary signs,and outcomes after descending to the same altitude).Binary Logistic regression analysis was performed to analyze the risk factors associated with HAPE.Results Of the 87 included subjects,92.1%were HAPE patients in group B and 26.5%in group A.On admission,the blood oxygen saturation of group B was significantly lower than that of group A,the total number of white blood cells,heart rate and respiration were significantly higher than that of group A.The incidence of positive pulmonary signs(wet rale)and positive imaging(double lung patular shadow)in group B was also higher than that of group A(P<0.05).The body temperature of group B was higher than that of group A.There was no significant difference between the two groups(P>0.05).Logistic regression analysis showed that altitude,sex,underlying disease and place of residence were all independent risk factors for HAPE,and the OR value of those with underlying disease was the highest(OR=17.667).Conclusion There are significant differences in the incidence of HAPE at different altitudes.Factors such as altitude,gender,place of residence and underlying diseases have significant effects on HAPE,especially those with underlying diseases have a higher risk.The above study will provide theoretical basis for reducing the incidence of HAPE in high-altitude regions for soldiers,tourists and workers who enter the plateau.