中度高原(1517m)胸部手术前后多脏器功能指标的变化趋势及临床意义

Changes and clinical significance of multiple organ function indexes around thoracic surgery performed on moderate high-altitude(1 517 m)

目的 :研究中度高原地区 (15 17m)胸部手术前后多脏器功能指标的动态变化。方法 :选择拟行食管癌手术患者 2 0例 ,根据设计 ,对多脏器评分要求的 33项指标进行手术前后动态观察。通过对MODS多器官功能指标标准、APACHEⅡ评分系统、SIRS标准等进行统计学分析 ,对比手术前后各相关器官指标的变化和全身炎症 /应激反应的水平。结果 :血气指标变化幅度较大 ,PaO2 /FiO2 、AaDO2 与术前相比P <0 .0 1,术后第 1、3、5天符合SIRS 2～ 4项标准依次为 10 0 %、90 %、6 0 % ;术后第 1、2天全部达到ALI标准 ,术后第 1、3、5天达到ARDS血气指标的依次为 95 %、80 %、5 0 % ;按庐山会议标准多脏器功能损伤可满足 2～ 4个器官评分标准的第 1、3、5天依次为 9例 (45 % )、8例 (40 % )和 10例 (5 0 % ) ;血小板计数、谷草转氨酶、Na+ 、血糖等器官功能指标术后第 1、3、5天与术前相比P <0 .0 5 ,P <0 .0 1。结论 :中度高原地区胸部手术后对多个器官功能指标影响较大 ,所有病例均可满足SIRS和ALI、ARDS血气标准 ,半数病例达到轻度MODS标准。表明平原ARDS/MODS标准不适用于中度高原地区 ,有必要对诊断标准和海拔高度作出适合实际的界定。

Objective: To study the dynamic changes of multiple organ function indexes around thoracic surgery performed on the moderate high-altitude(1 517 m). Methods: 20 patients with esophageal cancer were chosen and thirty three organ indexes were recorded before and after operation. The changes of organ indexes were analyzed with APACHEⅡ and the criteria of MODS and SIRS. Results: The changed range of arterial blood gases were great and PaO 2/FiO 2, AaDO 2 changed significantly (P<0.01). The indexes accorded with the criteria of SIRS 2 to 4 items on the 1st, 3rd and 5th day after operation were 100%, 90%, and 60% respectively.On the 1st and 2nd day, all of them reached ALI criteria. Platelet count, glutamic-oxalacetic transaminase, Na+ and blood sugar changed significantly around the operation (P<0.05, P<0.01). Conclusion: Thoracic surgery influenced multiple organ function indexes greatly on the moderate high-altitude. The criteria of ARDS/MODS at moderate high-altitude are different from that of the plain, a more practicable diagnostic criteria of moderate high-altitude is in urgent need.