Zhang Xue-feng, Ma Si-qing, Wu Shi-zheng, Yang Zheng-ping, Chen Qiang
High Altitude Disease Research Center, Germud City People's Hospital, Germud, Qinghai, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2012 Jul;24(7):415-8.
To discuss Bundle treatment of the acute severe type high altitude disease.
The prospective and randomized controlled trial was conducted. Two hundred and three patients with high altitude pulmonary edema (HAPE) or high altitude cerebral edema (HACE) met inclusion criteria were included, and were randomly divided into Bundle treatment group (n = 125) and conventional treatment control group (n = 78). Critical patients with multiple organ dysfunction syndrome (MODS) were admitted to intensive care unit (ICU); with respiratory failure or serious hypoxia of the patients were given mechanical ventilation (invasive or noninvasive); fluid resuscitation and vasoactive agents were given in the unstable hemodynamics patients; diuretics and continuous veno-venous hemofiltration were given in acute renal dysfunction or failure. The gastrointestinal bleeding and blood coagulation disorders were concerned. The hospital stay time, cure rate and mortality were compared according to the stages and classification of HAPE or HACE among two groups.
The hospital stay time was significantly decreased 1.66 days in the Bundle treatment group (days: 5.28 ± 3.17) compared with conventional treatment control group (6.94 ± 4.05, P < 0.05), the cure rate was significantly increased 7.06% (96.80% vs. 89.74%, P < 0.05), mortality of severe and fatal patients were decreased 5.59% and 31.15%, the mortality of patients in Bundle treatment group was significantly lower than conventional treatment control group (3.20% vs. 10.26%, P < 0.05).
The standardized treatment which was integrated with plateau medicine and critical care medicine can effectively reduce the mortality of critical or severe patients with HAPE or HACE.
探讨急性重症高原病的集束化治疗。
采用前瞻性随机对照试验。纳入203例符合纳入标准的高原肺水肿（HAPE）或高原脑水肿（HACE）患者，随机分为集束化治疗组（n = 125）和传统治疗对照组（n = 78）。合并多器官功能障碍综合征（MODS）的危重症患者入住重症监护病房（ICU）；呼吸衰竭或严重缺氧患者给予机械通气（有创或无创）；血流动力学不稳定患者给予液体复苏和血管活性药物；急性肾功能不全或衰竭患者给予利尿剂及持续静脉-静脉血液滤过。关注胃肠道出血及凝血功能障碍情况。比较两组患者根据HAPE或HACE分期及分型的住院时间、治愈率和死亡率。
集束化治疗组的住院时间较传统治疗对照组显著缩短1.66天（天数：5.28±3.17）（6.94±4.05，P<0.05），治愈率显著提高7.06%（96.80%对89.74%，P<0.05），重症及致死患者死亡率分别降低5.59%和31.15%，集束化治疗组患者死亡率显著低于传统治疗对照组（3.20%对10.26%，P<0.05）。
整合高原医学与危重症医学的规范化治疗可有效降低HAPE或HACE危重症患者的死亡率。
