CAJ | 학술논문

目的探讨高原(海拔3 658 m)不同人群重度创伤失血性休克(traumatic hemorrhagic shock,THS)患者并发症的特点及预防措施. 方法回顾性分析1976年10月-1990年10月采取传统复苏方法(传统复苏组,103例)和1991年10月-2012年10月采用综合治疗方法治疗(综合治疗组,488例)的世居高原藏族、移居高原汉族(移居高原3个月以上)和急进高原汉族(进入高原1周以内)重度THS患者共591例,并对结果进行比较. 结果传统复苏组世居高原藏族患者并发症主要有应激性溃疡2例,肺水肿1例,MODS 3例,死亡3例；移居高原汉族患者并发症主要有应激性溃疡9例,肺水肿8例,ARDS 3例,脑水肿1例,急性肾功能衰竭3例,弥散性血管内凝血(disseminated intravascular coagulation,DIC)2例,MODS 13例,死亡11例；急进高原汉族患者并发症主要有应激性溃疡5例,肺水肿4例,ARDS 4例,脑水肿2例,急性肾功能衰竭3例,DIC2例,MODS 6例,死亡4例.综合治疗组世居高原藏族患者、移居高原汉族患者、急进高原汉族患者的并发症发生率和死亡率均显著低于传统复苏组相应人群患者. 结论 (1)采用传统复苏方法的高原重度THS患者并发症多、发生早、发生率高、进展快、程度重、死亡率高；而且急进高原汉族重于移居高原汉族和世居藏族.(2)采取综合治疗方法可显著降低患者并发症的发生率和死亡率.(3)急进高原汉族患者对综合治疗方法的依赖程度大于移居高原汉族患者和世居藏族患者.
목적 탐토고원(해발3 658 m)불동인군중도창상실혈성휴극(traumatic hemorrhagic shock,THS)환자병발증적특점급예방조시. 방법 회고성분석1976년10월-1990년10월채취전통복소방법(전통복소조,103례)화1991년10월-2012년10월채용종합치료방법치료(종합치료조,488례)적세거고원장족、이거고원한족(이거고원3개월이상)화급진고원한족(진입고원1주이내)중도THS환자공591례,병대결과진행비교. 결과 전통복소조세거고원장족환자병발증주요유응격성궤양2례,폐수종1례,MODS 3례,사망3례；이거고원한족환자병발증주요유응격성궤양9례,폐수종8례,ARDS 3례,뇌수종1례,급성신공능쇠갈3례,미산성혈관내응혈(disseminated intravascular coagulation,DIC)2례,MODS 13례,사망11례；급진고원한족환자병발증주요유응격성궤양5례,폐수종4례,ARDS 4례,뇌수종2례,급성신공능쇠갈3례,DIC2례,MODS 6례,사망4례.종합치료조세거고원장족환자、이거고원한족환자、급진고원한족환자적병발증발생솔화사망솔균현저저우전통복소조상응인군환자. 결론 (1)채용전통복소방법적고원중도THS환자병발증다、발생조、발생솔고、진전쾌、정도중、사망솔고；이차급진고원한족중우이거고원한족화세거장족.(2)채취종합치료방법가현저강저환자병발증적발생솔화사망솔.(3)급진고원한족환자대종합치료방법적의뢰정도대우이거고원한족환자화세거장족환자.
Objective To investigate the features and prevention measures of complications secondary to severe traumatic hemorrhagic shock (THS) of different crowds in plateau (3 658 meters above the sea level).Methods A retrospective study was conducted on 591 severe THS patients undergone traditional resuscitation (traditional resuscitation group,n =103) from October 1976 to October 1990 and integrated treatment (integrated treatment group,n =488) from October 1991 to October 2012.The patients included native Tibetans,Han immigrants in plateau (≥ 3 months) and Han people who entered plateau rapidly (＜ 7 days).Outcome of the two treatments was compared.Results With regard to the traditional resuscitation group,native Tibetans sustained the main complications including stress ulcer (n =2),pulmonary edema (n =1),MODS (n =3) and death (n =3) ； Han immigrants in plateau sustained the main complications including stress ulcer (n =9),pulmonary edema (n =8),ARDS (n =3),cerebral edema (n =1),acute renal failure (n =3),disseminated intravascular coagulation (DIC) (n =2),MODS (n =13) and death (n =11)； Han people who entered plateau rapidly sustained the main complications including stress ulcer (n =5),pulmonary edema (n =4),ARDS (n =4),cerebral edema (n =2),acute renal failure (n =3),DIC (n =2),MODS (n =6) and death (n =4).Whereas in contrast to the relevant patient crowds in the traditional resuscitation group,the native Tibetans,Han immigrants in plateau and Han people who entered plateau rapidly presented significant reduction of complication rate and mortality rate in the integrated treatment group.Conclusions (1) Traditional resuscitation for severe THS patients in plateau results in much more complications with quick occurrence,high incidence,rapid progression,high severity and high mortality.Moreover,the complications are more severe in Han people who entered plateau rapidly than in the Han immigrants in plateau and native Tibetans.(2) The incidence of complications and death rate are significantly reduced after integrated treatment.(3) Han people who entered plateau rapidly present larger dependence on integrated treatment than the Han immigrants in plateau and native Tibetans.