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目的通过高原肺水肿(HAPE)不同治疗方案的疗效比较,对其规范化治疗进行初步探讨。方法将400例HAPE患者或随机分为A、B、C、D4组,A组给予吸氧、地塞米松、氨茶碱治疗,B组在A组基础上给予速尿治疗,C组在A组基础上给予硝苯地平治疗,D组在A组基础上给予左旋精氨酸治疗,并对4组的治疗效果及安全性(包括副作用及肝肾功能)进行综合评价,对其中安全、疗效显著的一组治疗方案进行规范化。结果 4种治疗方案对HAPE均具有明显的治疗作用,通过对其临床症状消失时间、体征消失时间、肺部X线阴影消失时间及住院时间比较,B组均显著低于A组、C组及D组(P<0.01或P<0.05),A组、C组及D组之间相互比较无显著差异;4种治疗方案安全性比较,C组副作用发生率显著高于A组、B组及D组(P<0.01),A组、B组及D组之间副作用及4组肝肾功能之间比较均无显著差异。结论以吸氧、地塞米松、氨茶碱、速尿组成的HAPE治疗方案具有使用方便、高效、安全的特点,可作为HAPE规范化治疗方案加以推广。
Objective To compare the curative effect of different treatment of high altitude pulmonary edema (HAPE) and to discuss its standardization treatment. Methods 400 HAPE patients were randomly divided into A, B, C and D4 groups. A group was treated with oxygen inhalation, dexamethasone and aminophylline, B group was treated with furosemide on the basis of A group, A group was treated with A Group was given nifedipine treatment, group D was treated with L-arginine on the basis of group A, and the therapeutic effect and safety (including side effects and liver and kidney function) of the four groups were evaluated comprehensively, and the safety and curative effect A significant group of treatment regimens were standardized. Results All the four treatment regimens had significant therapeutic effects on HAPE. Compared with the disappearance of clinical symptoms, disappearance of signs, disappearance of lung X-ray shadow and length of hospital stay, the B group was significantly lower than those of A group, C group and D group (P <0.01 or P <0.05). There was no significant difference between group A, group C and group D. The safety of the four treatment regimens was significantly higher than that of group A, group B and D group (P <0.01). There was no significant difference between the side effects of A, B and D groups and between the four groups of liver and kidney function. Conclusion The HAPE regimen consisting of oxygen inhalation, dexamethasone, aminophylline and furosemide is easy to use, highly effective and safe. It can be used as a standard HAPE regimen.