CAJ | 학술논문

目的探讨高原反应合并尿潴留的诊断治疗方法. 方法 2010年4月16日至4月26日收治高原反应合并尿潴留患者30例.均为男性.年龄19 ～38岁,平均24岁.均由低海拔地区(海拔600 ～1800 m)首次进驻高海拔地区(3600～5000 m).25例排尿次数由8～10次/d减少至2～4次/d,尿量由1500 ～2400 ml/d减少至600 ～ 800 ml/d；5例12 ～ 18 h未排尿,且无尿意.并发高原性肺水肿26例,高原性脑水肿4例.尿蛋白(+～++)2l例,B超检查发现双肾肾柱肿大30例.结果 30例均行导尿治疗,10 min引出尿液300 ～600 ml,12h引出尿液1800 ～2300 ml,18 ～ 24 h拔除导尿管后均恢复正常排尿.22例入院lh后,高原脑水肿、高原肺水肿症状明显好转；8例后送治疗5d,症状缓解.本组无死亡病例. 结论高原反应合并尿潴留是可逆性高原特发病之一,低气压、缺氧、高海拔是其可能病因；漏诊率高；吸氧、留置导尿治疗效果较好；穿增压服及阶梯性适应是最好的预防方法.
목적 탐토고원반응합병뇨저류적진단치료방법. 방법 2010년4월16일지4월26일수치고원반응합병뇨저류환자30례.균위남성.년령19 ～38세,평균24세.균유저해발지구(해발600 ～1800 m)수차진주고해발지구(3600～5000 m).25례배뇨차수유8～10차/d감소지2～4차/d,뇨량유1500 ～2400 ml/d감소지600 ～ 800 ml/d；5례12 ～ 18 h미배뇨,차무뇨의.병발고원성폐수종26례,고원성뇌수종4례.뇨단백(+～++)2l례,B초검사발현쌍신신주종대30례.결과 30례균행도뇨치료,10 min인출뇨액300 ～600 ml,12h인출뇨액1800 ～2300 ml,18 ～ 24 h발제도뇨관후균회복정상배뇨.22례입원lh후,고원뇌수종、고원폐수종증상명현호전；8례후송치료5d,증상완해.본조무사망병례. 결론 고원반응합병뇨저류시가역성고원특발병지일,저기압、결양、고해발시기가능병인；루진솔고；흡양、류치도뇨치료효과교호；천증압복급계제성괄응시최호적예방방법.
Objective To explore the diagnosis and treatment of altitude sickness combined with urinary retention. Methods 30 cases of altitude sickness combined with urinary retention were treated from April 16th to 26th,2010.They were all male,The average age of them was 24 years (range,19 -38).All were the first time entering the high altitude area (3600 -5000 m) from low altitude area (600 - 1800 m ).The urinary frequency of 25 patients reduced from 8 to 10 times/d to 2 to 4 times/d,the urine output reduced from the 1500- 2400 ml/d to 600- 800 ml/d; the other 5 patients had no urine in 12 -18 h,even had no sense to urinate.26 patients also combined with altitude pulmonary edema and 4 combined with altitude cerebral edema.30 patients had double renal columns enlarged,21 cases had urinary protein ( + ～ ++ ). Results 30 patients were exported urine 300 -600 ml within 10 min,leaded to urine 1800 -2300ml in 12 h,returned to normal voiding after catheter removal in 18 -24 h. After comprehensive treatment such as oxygen,dehydration,diuretic,sedative,antispasmodic and anti-infection,22 cases who with chest tightness,shortness of breath,dyspnea,hemoptysis foam sputum,headache,vomiting and other symptoms of jet-like improved apparently after hospital admission within 1 hour.Their heart rate downed from 90 - 145beats/min to 68 -92 beats/min,respiration from 28 -45 times/min to 18 - 28 times/min,oxygen saturation from 48％ - 84％ to 92％ - 100％ ; 8 cases who with shortness of breath,palpitation and headache improved not obviously.After the antihypertensive treatment,their blood pressure was still high (systolic blood pressure 150 - 180 mm Hg,diastolic blood pressure 90 -110 mm Hg),oxygen saturation between 78％ to 87％,so they were carried to rear area for further treatment.30 cases were all cured no death. Conclusions The high altitude urinary retention is reversible disease,which is often associated with high altitude pulmonary edema,altitude cerebral edema,acute subclinical renal dysfunction and gastrointestinal disorders.They are easily being induced by elements such as gastroenteritis,lung infection,tonsillitis,periodontitis,tiredness and so on; low atmospheric pressure,hypoxia and high altitude is the possible cause; the ratio of missed diagnosis is high; the treatment of oxygen and indwelling catheterization is better; The best method of prevention is to wear pressurized suits and adapt the environment in a ladder-step gradual way.