高原环境下慢性高原病并发急性高原病的临床回顾

A retrospective clinical study of chronic high altitude disease complicated by acute exacerbation in high altitude environment

目的 了解在高原环境下慢性高原病患者并发急性高原病的情况。方法 对地处海拔36 5 8米本院 4 0年间 (195 6年 1月至 1995年 12月 )收治的符合筛选标准的 180 90例住院病历为样本 ,随访 1～ 15年不等 ,分为两组 ,病例组为慢性高原病住院者 ,对照组为非高原病首次住院者。观察急性高原病的发病情况并进行临床流行病学的分析。结果 ①对照组急性高原病发病率随观察年限延长而增加 ,病例组无此现象。急性高原病的逐年发病率与累计发病率 ,病例组显著高于对照组 (P <0 0 0 5 ) ,相对比数比 (OR) =5 0 3,相对危险度 (RR) =4 33;②三型急性高原病发病率除高原高血压组的高原肺水肿与高原心脏病组的高原脑水肿发病率外 ,余在病例组显著高于对照组 (P <0 0 5～0 0 0 5 )。高原心脏病与蒙赫病组急性高原病发病率分别为 2 3 5 % ,2 1 98%。OR =7 33～ 6 71,RR =5 86～ 5 4 7;③高原心脏病组和蒙赫病组的急性高原病发病率构成以急性轻型高原病为主。结论慢性高原病患者发生急性高原病风险比高原习服人群增加 5倍 。

Objective To study chronic high altitude disease (CHAD) with concurrent acute high altitude disease (AHAD) in regions of high altitude Methods 18 090 inpatients from Feb 1956 to Dec 1995 conforming to a screening standard were observed in a hospital located at altitude 3658m 1 028 inpatients suffering from CHAD when hospitalized were collected as a study group 17 020 inpatients suffering from non HAD when first hospitalized served as a control group The morbidity rate of AHAD in these two groups in a follow up period of 1 20years was analyzed Results ① AHAD morbidity rate was increasing with prolongation of observation time in the control group,but it was not so in the study group Annual and accumulative morbidity of AHAD in the study group was obviously higher than that in the control group( P <0 005, OR =5 03, RR =4 33) ②The morbidity rates of three types of AHAD aside from high altitude pulmonary edema (HAPE) of high altitude hypertensiom (HAH) group and high altitude cerebral edema (HACE) of high altitude heart disease (HAHD) group was obviously higher in the study group than in the control ( P <0 05～0 005) AHAD morbidity rate in HAHD group and Monge′s disease was 23 5% and 22 0%( OR =7 33～6 71, RR =5 86～5 47) ③AHAD morbidity rate in HAHD group and Monge′s disease group was obviously higher than that in the control, constituting mainly a high morbidity of mild acute high altitude disease Conclusion The risk of AHAD increases about 5 fold in CHAD patients than in the multitude of high altitude acclimatization,being most evident in HAHD and Monge′s disease