青藏高原高原肺水肿的临床特征及实验室与影像学特点

doi:10.24920/11813

摘要/Abstract

摘要：

目的分析中国人高原肺水肿的临床特征及实验室与影像学特点。方法本研究对98例高原肺水肿患者进行了回顾性分析,通过阅读病历、统计分析,总结了高原肺水肿患者住院时及出院前的临床特征、实验室及影像学特点。结果 48例患者(49.0%)在海拔2800米至3000米发生高原肺水肿,95例患者 (96.9%)是男性。湿罗音分布在两肺,14例患者右肺的湿罗音强度强于左肺。入院时,患者的白细胞计数[（12.83±5.55)×109/L比(8.95±3.23)×109/L,P=0.001）]及中性粒细胞计数[（11.34±3.81)×109/L比(7.49±2.83)×109/L,P=0.001）]显著高于出院时,而白细胞的其他类型计数显著低于出院时。入院时的血清碱性磷酸酶（115.8±37.6 mmol/L比85.7±32.4 mmol/L,P=0.020）,胆碱酯酶（7226.2± 1631.8 mmol/L比6285.3±1693.3 mmol/L,P=0.041）,肌酐（401.9±114.2 mmol/L比75.1±12.8 mmol/L,P=0.021）,尿酸（85.2±17.1 mmol/L比326.0±154.3,P=0.041）,以及尿糖浓度（7.20±1.10 mmol/L比5.51±1.11 mmol/L,P=0.001）显著高于出院时。入院时的二氧化碳结合力（26.7±4.42 mmol/L比28.9±4.50 mmol/L,P=0.042）及血清钙（2.32±0.13比2.41±0.10 mmol/L,P=0.006）显著低于出院时。入院时血气分析表现为低氧血症合并呼吸性碱中毒。结论男性更容易发生高原肺水肿,发生高原肺水肿时右肺损伤较左肺为重。高原肺水肿发生时部分血常规、血生化、血气分析结果发生变化。

关键词: 高原, 肺水肿, 临床特征, 实验室特点

Abstract:

Objective To analyze characteristics of high altitude pulmonary edema (HAPE) in Chinese patients.Methods We performed a retrospective study of 98 patients with HAPE. We reviewed the medical records and summarized the clinical, laboratory and imaging characteristics of these cases, and compared the results on admission with those determined before discharge.Results Forty-eight (49.0%) patients developed HAPE at the altitude of 2800 m to 3000 m. Ninty-five (96.9%) patients were man. Moist rales were audible from the both lungs, and moist rales over the right lung were clearer than those over the left lung in fourteen patients. The white blood cells [(12.83±5.55) versus (8.95±3.23) ×10 ⁹/L, P=0.001)] as well as neutrophil counts [(11.34±3.81) versus (7.49±2.83)×10 ⁹/L, P=0.001)] were higher, whereas the counts of other subsets of white blood cells were lower on admission than those after recovery (all P<0.05). Serum levels of alkaline phosphatase (115.8±37.6 versus 85.7±32.4 mmol/L, P=0.020), cholinesterase (7226.2±1631.8 versus 6285.3±1693.3 mmol/L, P=0.040), creatinine (85.2±17.1 versus75.1±12.8 mmol/L, P=0.021), uric acid (401.9±114.2 versus 326.0±154.3 mmol/L, P=0.041), and uric glucose (7.20±1.10 versus 5.51±1.11 mmol/L, P=0.001) were higher, but carbondioxide combining power (CO₂CP, 26.7±4.4 versus 28.9±4.5 mmol/L, P=0.042) and serous calcium (2.32±0.13 versus 2.41±0.10 mmol/L, P=0.006) were lower on admission. Arterial blood gas results showed hypoxemia and respiratory alkalosis on admission. Conclusions In the present research, men were more susceptible to HAPE than women, and in the process of HAPE, the lesions of the right lung were more serious than those of the left lung. Some indicators of routine blood test and blood biochemistry of HAPE patients changed.

Key words: high altitude pulmonary edema, clinical feature, laboratory feature

Li Zongbin, Chen Hongyan, Li Jiayue, Li Gaoyuan, Liu Chunwei, Chen Yundai. Clinical, Laboratory and Imaging Features of High Altitude Pulmonary Edema in Tibetan Plateau[J].Chinese Medical Sciences Journal, 2018, 33(3): 160-166.

图/表 2

Table 1

Table 2

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Variables	Admission	Discharge	t value	P value
RBC (×10¹²/L)	5.13±0.48	4.93±0.54	1.974	0.040
Haemoglobin (g/L)	164.7±19.8	155.5±16.1	2.862	0.003
Platelet (×10⁹/L)	209.3±46.5	192.8±43.3	1.825	0.041
WBC (×10⁹/L)	12.83±5.55	8.95±3.23	5.623	0.001
Neutrophil (×10⁹/L)	11.34±3.81	7.49±2.83	3.812	0.001
Monocyte (×10⁹/L)	0.72±0.25	0.87±0.26	-1.912	0.030
Basophil (×10⁹/L)	0.04±0.05	0.13±0.10	-2.016	0.022
Lymphocyte (×10⁹/L)	1.73±0.69	2.20±0.87	-2.045	0.020
Eosinophil (×10⁹/L)	0.03±0.02	0.10±0.06	-3.620	0.001
MPV(fl)	9.83±1.12	11.03±1.22	-2.628	0.002
Haematocrit (%)	48.7±6.20	44.9±5.10	3.034	0.001
MCV (fl)	93.7±5.90	92.3±5.70	1.198	0.140
MCH (%)	31.6±1.50	32.6±1.60	-0.816	0.280
MCHC (g/L)	338.7±13.8	348.4±18.6	-2.115	0.030

Variables	Admission	Discharge	t value	P value
UA (mmol/L)	401.9±114.2	326.0±154.3	1.527	0.041
Na⁺ (mmol/L)	140.1±4.9	141.8±3.800	-1.120	0.191
K⁺ (mmol/L)	4.17±0.37	4.18±0.18	-0.151	0.812
Cl^- (mmol/L)	100.7±2.6	100.8±3.5	-0.223	0.861
Ca²⁺ (mmol/L)	2.32±0.13	2.41±0.10	-2.250	0.006
Alanine aminotransferase (U/L)	29.1±16.1	24.9±9.90	0.709	0.150
Aspartate aminotransferase (U/L)	22.2±9.40	19.6±6.60	0.749	0.381
Glucose (mmol/L)	7.20±1.10	5.51±1.11	5.263	0.001
TBIL (mmol/L)	18.8±9.80	12.2±4.91	1.915	0.030
DBIL (mmol/L)	7.12±3.50	6.91±3.64	0.143	0.850
IBIL (mmol/L)	15.8±13.5	7.21±3.70	1.516	0.041
Cr (mmol/L)	85.2±17.1	75.1±12.8	2.125	0.021
TP (mmol/L)	70.3±8.41	62.5±6.82	2.545	0.005
ALB (mmol/L)	42.9±4.21	39.2±4.01	2.175	0.010
AKP (mmol/L)	115.8±37.6	85.7±32.4	2.061	0.020
CHE (mmol/L)	7226.2±1631.8	6285.3±1693.3	2.353	0.040
BUN (mmol/L)	6.92±3.71	6.32±1.54	0.729	0.472
CO₂CP (mmol/L)	26.7±4.4	28.9±4.5	-2.177	0.042

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