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The Incidence of Acute Mountain Sickness and its Treatment

短期进入高原从事高强度工作所致高原反应是值得探讨的问题,查阅文献,探讨其病因及发病机理、临床表现,总结国内外在诊断、预防及治疗方面的经验,探索一套可行、有效的预防及治疗措施,具有重要的临床意义。

The Adaption of Hypoxia Induced Pulmonary Hypertension to Polycythemia in Rats

目的:研究低氧性肺动脉高压大鼠对实验性红细胞增多的适应。方法:健康SD大鼠28只,体重200～250 g,随机分为4组:常氧对照组（N）、单纯低氧组（H）、低氧+低剂量人重组促红细胞生成素（rEPO） 600 u/kg（H+E1）组、低氧+高剂量rEPO 1200 u/kg（H+E2）组,每组7只大鼠。除常氧对照组外各低氧组大鼠均缺氧21 d,每日8 h。其中后两组每周腹部皮下注射不同剂量的rEPO三次。取血样测定红细胞数、全血粘度及红细胞变形指数；颈外静脉插管测定平均肺动脉压力；光镜观察反映肺动脉重构程度的形态学参数肺小动脉管壁厚度百分比、肺非肌性小动脉肌化程度。结果:①随着rEPO注射剂量的增加,红细胞、全血粘度有不同程度的增高；②全血粘度增高的同时红细胞变形指数也相应地增加；③随着rEPO剂量的增加,平均肺动脉压力逐渐增高,但是肺血管重构程度反而有所缓解。结论:实验性红细胞增多通过改变红细胞变形性和缓解肺血管重构程度来阻遏低氧性肺动脉高压的进一步发展。

高原地区25例结核性肠梗阻的外科治疗

目的探讨高原地区结核性肠梗阻外科治疗的时机以及术式的选择。 方法对2010年6月至2012年6月期间笔者所在医院科室收治的25例结核性肠梗阻患者的临床资料进行回顾性分析。 结果25例患者中术前确诊7例，疑似诊断14例，误诊为消化道穿孔2例、阑尾炎2例。均经保守治疗48～72 h无效后行剖腹探查术，其中行肿大淋巴结切除术1例，脓肿引流术3例，单纯粘连松解术13例，行粘连松解+肠切除吻合术6例，仅行腹腔引流术1例，行一期坏死肠段切除二期肠吻合手术1例。25例患者术后病理学检查结果：肠系膜淋巴结结核4例，腹膜结核合并小肠结核21例。术后10 d和13 d分别死亡1例，术后给予抗结核治疗，23例治愈，随访2年无复发。 结论短期保守治疗无效的结核性完全性肠梗阻患者应尽早手术，术式宜简单、直接，不宜过度追求手术的彻底性；应重视围手术期抗结核治疗和综合性支持治疗。

Safety and feasibility of thoracic surgery for high-altitude patients in the high-altitude medical center

Objective To investigate the safety of thoracic surgery for high-altitude patients in local medical center. MethodsWe retrospectively collected 258 high-altitude patients who received thoracic surgery in West China Hospital, Sichuan University (plain medical center, 54 patients) and People's Hospital of Ganzi Tibetan Autonomous Prefecture (high-altitude medical center, 204 patients) from January 2013 to July 2019. There were 175 males and 83 females with an average age of 43.0±16.8 years. Perioperative indicators, postoperative complications and related risk factors of patients were analyzed. ResultsThe rate of minimally invasive surgery in the high-altitude medical center was statistically lower than that in the plain medical center (11.8% vs. 55.6%, P<0.001). The surgical proportions of tuberculous empyema (41.2% vs. 1.9%, P<0.001) and pulmonary hydatid (15.2% vs. 0.0%, P=0.002) in the high-altitude medical center were statistically higher than those in the plain medical center. There was no statistical difference in perioperative mortality (0.5% vs. 1.9%, P=0.379) or complication rate within 30 days after operation (7.4% vs. 11.1%, P=0.402) between the high-altitude center and the plain medical center. Univariate and multivariate analyses showed that body mass index≥25 kg/m2 (OR=8.647, P<0.001) and esophageal rupture/perforation were independent risk factors for the occurrence of postoperative complications (OR=15.720, P<0.001). ConclusionThoracic surgery in the high-altitude medical center is safe and feasible.

Current situation and demand analysis of emergency and critical care training for medical staff in different levels of hospitals in plateau areas

Objective To analyze the current situation and demand of emergency and critical care training for medical staff in plateau areas, and to provide a reference for further emergency and critical care training for medical staff in plateau areas. Methods From July 1, 2018 to July 30, 2020, medical staff (including physicians, nursing staff, and other medical staff) from hospitals in various regions of Tibet were surveyed anonymously, to investigate the content and demand of medical staff in plateau areas receiving emergency and critical care training. The content and demand of medical staff from different levels of hospitals receiving emergency and critical care training were further compared. Results A total of 45 questionnaires were distributed in this study, and a total of 43 valid questionnaires were collected, with an effective response rate of 95.6%. The average age of medical staff was (35.67±9.17) years old, with a male to female ratio of 1∶1.5. The proportion of tertiary, secondary, and lower level hospitals to which medical staff belong were 23.3%, 27.9%, and 48.8%, respectively. The number and proportion of medical staff receiving training on chest pain, heart failure, stroke, gastrointestinal bleeding, respiratory failure, metabolic crisis, and sepsis diseases were 25 (58.1%), 25 (58.1%), 24 (55.8%), 23 (53.5%), 20 (46.5%), 14 (32.6%), and 12 (27.9%), respectively. The number and proportion of medical staff who believed that training in the heart failure, respiratory failure, metabolic diseases, stroke, gastrointestinal bleeding, chest pain, and sepsis needed to be strengthened were 38 (88.4%), 36 (83.7%), 35 (81.4%), 34 (79.1%), 34 (79.1%), 33 (76.7%), and 29 (67.4%), respectively. Thirteen medical staff (30.2%) hoped to acquire knowledge and skills through teaching. There were no statistically significant differences in gender, age, job type, professional title, and department type among medical staff from tertiary, secondary, and lower level hospitals participating in the survey (P>0.05). The proportion of medical staff in hospitals below secondary receiving training on chest pain was lower than that in second level hospitals (38.1% vs. 91.7%). The proportion of medical staff in hospitals below secondary receiving training on heart failure was lower than that in secondary and tertiary hospitals (38.1% vs. 75.0% vs. 80.0%). The proportion of medical staff in hospitals below secondary receiving training on respiratory failure was lower than that in tertiary hospitals (28.6% vs. 80.0%). The demand for sepsis training among medical staff in hospitals below secondary was higher than that in tertiary hospitals (85.7% vs. 30.0%). There was no statistically significant difference in the other training contents and demands (P>0.05). Conclusion The content of critical care training for medical staff in plateau areas cannot meet their demands, especially for medical staff in hospitals below secondary. In the future, it is necessary to strengthen training support, allocate advantageous resources to different levels of hospitals, expand the scope of training coverage, and enrich training methods to better improve the ability of medical personnel in plateau areas to diagnose and treat related diseases.

高原地区交锁髓内钉治疗胫腓骨骨折骨不愈合

高原地区诱发胆囊结石的危险因素

胆囊结石是危害人体健康的常见病和多发病。在高原地区除了特殊的地理环境外，不良的饮食习惯、特殊的饮食结构和缺乏运动是发生胆囊结石的高危因素，分析胆囊结石发病率的危险因素，针对性地普及健康饮食及生活的指导，降低胆囊结石的发病率，提高藏民族的生活质量是关键。

高原腕关节结核的诊断与治疗

目的 总结高原地区腕关节结核的诊断及治疗方法。 方法 回顾分析2007 年10 月－ 2009 年10月25 例腕关节结核患者临床资料。男12 例，女13 例；年龄25 ～ 65 岁，平均34.6 岁。左腕15 例，右腕 10 例。其中15例有肺结核或既往有肺结核病史。腕关节结核发病至入院时间为2 ～ 8 个月，平均6 个月。单纯腕关节滑膜结核10 例行保守治疗；全腕关节结核12 例、腕部屈肌腱腱鞘结核3 例采用化疗联合手术病灶清除治疗。 结果 治疗后除2 例全腕关节结核及1 例腕部屈肌腱腱鞘结核患者切口Ⅱ期愈合外，其余患者切口均Ⅰ期愈合。患者均获1 年6 个月随访。随访期间无结核复发，切口周围均无再次窦道形成。10 例单纯腕关节滑膜结核者及3 例腕部屈肌腱腱鞘结核者腕关节、掌指关节及指间关节活动自如，均于治疗后2 个月完全恢复劳动。12 例全腕关节结核者前臂旋前平均70°、旋后70°，较术前明显改善，术后4 个月完全恢复劳动。 结论 早期诊断、手术前后联合化疗、及时手术清除病灶、术后腕关节石膏固定、同时加强各掌指及指间关节活动，是治疗腕关节结核的有效方法。

Study on the distribution characteristics of bone metabolic markers in plateau builders and the influencing factors

ObjectiveTo study the distribution of bone-specific alkaline phosphatase (BALP), type Ⅰ collagen cross-linked C-telopeptide (CTX) and tartrate-resistant acid phosphatase (TRAP)-5b in plateau area builders, and analyze the influencing factors under plateau environment. MethodsBetween April and May, 2014, using random stratified cluster sampling, we included in our study 650 blood samples from the power grid construction people in Batang County of Ganzi Autonomous Prefecture of Sichuan Province and Mangkang County of Tibet Autonomous Region with an altitude ranging from 2 600 to 4 450 meters, averaging (3 586.50±610.85) meters. We collected their fasting blood and detected their TRAP-5b, CTX and BALP by enzyme-linked immunosorbent assay method. By using SPSS 13.0, we analyzed the relationship between TRAP-5b, CTX, BALP and the influencing factors such as age, working intensity, residence time in the plateau area and altitude of the plateau. In the end, we tried to find out the main influencing factors of bone metabolic markers in the plateau environment.ResultsThe levels of CTX, BALP and TRAP-5b were the highest before the age of 20, and the average levels of them were respectively (1.04±0.38) ng/mL, (52.09±14.62) μg/L, and (4.22±1.38) U/L. With the increase of age, the levels of CTX, TRAP-5b and BALP showed a downward trend, but CTX and BALP reached the lowest level in the age group of 40 to 49 years old, and the average levels of CTX and BALP were (0.44±0.26) ng/mL and (24.77±9.89) μg/L, respectively. Then they gradually increased after the age of 50. TRAP-5b reached the lowest level in the age group of 30 to 39 years old, and the average level of TRAP-5b was (2.59±0.95) U/L. Then it gradually increased after the age of 40. The activity of CTX and BALP increased obviously with the increase of altitude. With the increase of labor intensity, BALP, TRAP-5b and CTX all increased. However, no matter what labor intensity, the bone formation marker BALP first increased and then decreased with the plateau residence time, while the bone absorption marker TRAP-5b increased after the first reduction.ConclusionsBone metabolic markers are different in different age groups. Altitude, working intensity and plateau working time have significant effects on bone metabolism markers.

Comparison of Laparoscopic Cholecystectomy between the Highland and Non-highland Area

【摘要】　目的　探讨高原地区腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）患者的特点，以便更好地进行围手术期处理。　方法　对2009年2月-2010年5月收治的长期生活在西藏高原地区的患者（高原组）367例和非高原地区患者（非高原地区组）167例的一般资料、术前诊断、合并症情况进行回顾性分析，两组患者性别、年龄及病程比较，差异无统计学意义（Pgt;0.05），有可比性。两组患者诊断均以胆囊结石为主，其次为胆囊息肉，诊断构成比较，差异无统计学意义（Pgt;0.05）；两组患者合并症比较，高原组患者高血压、冠心病、血红蛋白增多症及窦性心动过缓的发生率高于非高原地区组（Plt;0.05）；肺部疾病、肝硬化、糖尿病及脑梗死的发生率两组患者比较差异无统计学意义（Pgt;0.05）。两组患者均采用常规LC进行治疗，对两组患者术后临床结果、并发症等进行统计学分析。　结果　高原组患者手术中转开腹率（7.1%）高于非高原地区组（2.4%）患者（Plt;0.05）；高原组患者较非高原地区组患者住院时间长、手术时间长、术中出血量多（Plt;0.05）；术后并发症比较差异无统计学意义（Pgt;0.05）。　结论　高原地区LC患者宜及时中转开腹，其围手术期处理得当将有助于减少术后并发症的发生。【Abstract】　Objective　To explore the characteristics of patients undergoing laparoscopic cholecystectomy in highland area, in order to carry out better perioperative management.　Methods　We collected and analyzed the general information, preoperative diagnosis and complications of 367 patients living in highland area and 167 patients living in inland between February 2009 and May 2010. There was no significant difference between the two groups in sex, age and course of disease (Pgt;0.05). Cholecystolithiasis was the main disease followed by gallbladder polyps, and there was no difference between them in the kind of diseases (Pgt;0.05). The incidence of hypertension, coronary heart disease, hereditary persistence of fetal hemoglobin and sinus bradycardia was higher in patients in highland area than that in patients in non-highland area (Plt;0.05). There was no significant difference in the incidence of lung disease, liver cirrhosis, diabetes mellitus and cerebral infarction between the two groups (Pgt;0.05). Conventional laparoscopic cholecystectomy was conducted in both two groups. Comparative analysis of treatment outcome and postoperative complications was done.　Results　The rate of conversion from laparoscopic surgery to laparotomy in Tibetan patients (7.1%) was higher than that in patients in non-highland area (2.4%) (Plt;0.05). Hospitalization time, operation time and blood loss in Tibetan patients were significantly higher than those in patients in non-highland area (Plt;0.05), but there was no significant difference in postoperative complications between the two groups of patients (Pgt;0.05).　Conclusions　Laparoscopic cholecystectomy for patients in highlardarea should be converted to laparotomy when necessary. Appropriate perioperative management is helpful in reducing the incidence of postoperative complications.