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某部进驻5100m高原初期发生高原肺水肿20例,现将就地诊治经过总结如下。 病例资料 本组20例符合《高原适应不全症防治手册》诊断标准。系18～32岁男性青年,原驻地海拔低于2000m,3日内乘汽车急速进驻5100m高原地区。首次登山者易发病。初入1～4日发病率高,发病诱因为劳累(20/20)、轻中度高山反应(15/20)、上感(11/20)和寒冷(5/20)等。常见症状、体征为气短、胸闷、咳嗽,咯痰,心悸、发绀、肺部湿罗音等;部分伴表情淡漠、四肢麻木、乏力、倦怠、抽搐等。X线检查:双肺野大小不一,密度不匀的点片状及云雾状阴影(肺泡性肺水肿,13/20);肺纹增多、粗乱、模糊、肺透光度降低(间质性肺水肿,(7/20)。化验血常规基本正常。 治疗(1)绝对卧床,加强护理,易消化饮食;(2)吸氧:间质性肺水肿鼻导管吸氧,流量2～3L/min,肺泡性肺水肿4～6L/min;(3)氨茶硷0.25g加50％葡萄糖液80ml缓慢静注2次/日;(4)预防感染:首选青、链霉素(或其它抗生素);(5)利尿脱水:酌情选用速尿、利屎酸钠等;(6)激素:重症者选用地塞米松、氢化可地松等;(7)其它治疗:以对症处理为主。如烦躁给予镇静,呕吐频繁给灭吐灵,水、电解质、酸硷平衡失调给予纠正,纳差补液加维生素C等。经上述治疗,2～5天治愈者11/20,6～9天治愈者6/20,10天以上治愈者3/20,无死?
A ministry stationed in 5100m plateau early high altitude pulmonary edema occurred in 20 cases, now the diagnosis and treatment are summarized as follows. Case data The group of 20 cases meet the “Highland Adaptation Prevention Handbook” diagnostic criteria. Department of young men aged 18 to 32, the original resident altitude less than 2000m, 3 days by car quickly stationed 5100m plateau. First time climbers prone to disease. First to 4 days incidence of high incidence of fatigue due to (20/20), moderate to moderate mountain reaction (15/20), the sense of the flu (11/20) and cold (5/20) and so on. Common symptoms, signs of shortness of breath, chest tightness, cough, expectoration, palpitations, cyanosis, lung wet rales, etc .; some with apathy, limb numbness, fatigue, fatigue, convulsions and so on. X-ray examination: lung fields of different sizes, uneven density of the patchy and cloudy shadow (alveolar pulmonary edema, 13/20); increased lung pattern, rough chaos, blurred, reduced lung transparency (interstitial (2) Oxygen inhalation: interstitial pulmonary edema Nasal catheter oxygen, the flow of 2 ~ 3L (7/20) .The blood test was normal. Treatment (1) absolute bed rest, intensive care, digestible diet; / min, alveolar pulmonary edema 4 ~ 6L / min; (3) 0.25g ammonia plus alkali and 50% glucose solution 80ml slow intravenous injection 2 times / day; (4) Prevent infection: preferred green, streptomycin (or other Antibiotics); (5) diuretic dehydration: furosemide, Lee feces, as appropriate, and so on; (6) hormones: severe dexamethasone, hydrocortisone, etc .; (7) other treatment: symptomatic treatment based. Such as irritability to give calm, vomiting to exocupine, water, electrolyte, acid-base balance disorders to give correction, anorexia rehydration plus vitamin C. After the treatment, 2 to 5 days to cure 11/20, 6 to 9 days to cure 6/20, 10 days or more cured 3/20, no death?