【摘要】 目的:探讨全身炎症反应综合征(SIRS)和急性高原反应综合征(AHARS)相关关系。方法:随机将实验动物分为平原组(FG)、中度高原组(MHG)、高原组(HG)。分别制备绵羊肺淋巴造瘘、兔及鼠盲肠结扎穿孔、30%Ⅲ度烧伤SD大鼠等SIRS/MODS动物模型,比较同类指标参数在不同海拔高度的差异;临床研究将符合MODS标准的540例分为FG、MHG1、MHG2、HG组,比较MODS指标评分在不同高度上的差异,检验MODS预测结局的准确性。结果:动物模型组PAP、PAWP、QL、PS、PC、TXB2、PGF ia、ET-1、CGRP、L-ENK、HSP70等指标在不同高度差异显著(P<0.05)。临床资料有与动物模型近似的变化(P<0.05),高原评分标准优于平原通用标准(P<0.05)。结论:高原缺氧为主的暴露因素与各种外源性致伤因素介导的SIRS/ARDS/MODS可能与AHARS有共同的病生基础,均可导致急性全身炎症反应。建立一体化的评分系统可能有利早期诊断治疗、提高治愈率、降低死亡率。更多还原

【Abstract】 Objective:To investigate the pathophysiologic changes of systemic inflammatory response syndrome(SIRS) and acute high altitude reaction syndrome(AHARS) as well as relationship between each other.Methods: Clinical cases and animal models were respectively randomly divided into three groups: high altitude group,moderate high altitude group and flat land group.SIRS/ARDS models were established by making lung lymph fistula in sheep,by cecum ligation and puncture in rabbits and KM mice,and by severe TBSA burn in SD rats.A clinical multicenter research was completed by using the same criteria in 540 MODS patients.Three MODS diagnostic criteria were used and the accuracy of prognosis was tested comparatively.Results: ① In animal model groups,there were significant difference in many parameters such as PAP,PAWP,QL,PS,PC,TXB2,PGFia,ET-1,CGRP,L-ENK and HSP70 in three different altitudinal groups.②Analysis of area under ROC curve,sensitivity,specificity and 95% confidence interval indicated that the diagnostic criteria in high altitude was superior to that in flat land(P<0.05).Conclusion: There is probably common pathophysiologic basis in both AHARS and SIRS/ARDS/MODS induced by plateau hypoxia or other exogenous insults factors.A united diagnostic scoring system should be established and it may be helpful for increasing early-stage diagnosis rate and decreasing mortality rate.更多还原