玉树地震外来卫生应急人员急性高原反应及其影响因素分析
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摘要
目的分析玉树地震后外来卫生应急人员急性高原反应发生情况及引起急性高原反应的危险因素,为日后高原地区开展大规模医疗应急救援时有效保障应急救援人员的安全和健康提供科学依据。方法从参加2010年4月14日玉树地震的25支救援队伍中随机选取来自不同海拔地区的4支队伍,共67名队员进行问卷调查,了解他们急性高原反应发生情况及其危险因素。结果 67名被调查者中有54名(81%)作出应答,其中93%为男性,中位年龄36岁(24～55岁),有34人(63%)发生急性高原反应。单因素分析结果显示:居住在海拔<100 m者高原反应评分高于居住在海拔>1000 m者(分别为10分和5.2分,P=0.005);未到过高海拔地区者的高原反应评分高于曾到过高海拔地区者(分别为10分和6.4分,P=0.039);事先在海拔>2000 m地区停留不同天数者的高原反应评分不同(停留≥3天者为5.7分,停留≤1天者为9.4分,P=0.011);随身行李重量不同者的高原反应评分不同(≥25 kg者为9.8分,≤25 kg者为5.5分,P=0.002)。多元线性回归分析结果显示:原居住地海拔低和进入高原前的适应时间短是高原反应程度的影响因素[y=2.89–0.187×原居住地高度(每100 m)–2.43×进入玉树前在海拔超过2000 m地区的停留时间(d)]。结论既往经历和到达高原地区前的准备情况是影响急性高原反应的重要因素,应采取有效措施保护进入高原地区的应急救援人员的安全和健康。
Objective To assess the acute high altitude sickness(AHAS) and its risk factors among public health emergency responders,so as to provide scientific proof for guaranteeing the safety and health of emergency rescue workers.Methods The self-administered questionnaire aim at learning AHAS occurrence and its risk factors were distributed to 67 members from 4 teams at different altitudes selected among 35 rescue teams.The AHAS could be diagnosed by a total score of more than or equal to 5 within 3 days since arrival,as in the following detail: 1-3 score could be assigned in accordance with the following symptoms in degrees of the mild,moderate or severe,respectively: headache,nausea or vomiting,lassitude,dizziness and blurred vision,and sleep disorder;and 1 score could be assigned for each of the following symptoms: palpitation,shortness of breath,nosebleed,chest distress,diarrhea,constipation,cyanochroia of the lips,numbness in hands and feet,and dry cough.Results A total of 54 among 67(81%) responders completed the questionnaire,among whom 93% were males and the median age was 36 with the scope from 24 to 55,and 63%(34 respondents) developed AHAS.The univariate analysis showed that the altitude of the responders' original residence(10 score for "<100 m" vs.5.2 score for ">1 000 m",P=0.005),experiences in high altitude areas(10 score for "having not" vs.6.4 score for "having",P=0.039),length of stay in an area over 2 000 m altitude before arrival(9.4 score for "≥3 days" vs.5.7 score for "≤1 day",P=0.011),luggage weight(9.8 score for "≥25 kg" vs.5.5 score for "<25 kg",P=0.002) were correlated with AHAS severity.The multivariate linear regression indicated that the lower altitude of the responders' original residence and the short stay in an area over 2000m altitude before arrival were the factors influencing the severity of AHAS.The linear regression formulation was Y= 2.89-0.187 × the altitude of the responders' original residence(pre 100m) + 2.43 × the length of stay in an area over 2000m altitude before arriving at Yushu(day).Conclusions The past experiences and the pre-arrival preparation are critical factors of AHAS.Measures should be taken to protect the safety and health of responders dispatched to high altitude areas.
Objective To assess the acute high altitude sickness(AHAS) and its risk factors among public health emergency responders,so as to provide scientific proof for guaranteeing the safety and health of emergency rescue workers.Methods The self-administered questionnaire aim at learning AHAS occurrence and its risk factors were distributed to 67 members from 4 teams at different altitudes selected among 35 rescue teams.The AHAS could be diagnosed by a total score of more than or equal to 5 within 3 days since arrival,as in the following detail: 1-3 score could be assigned in accordance with the following symptoms in degrees of the mild,moderate or severe,respectively: headache,nausea or vomiting,lassitude,dizziness and blurred vision,and sleep disorder;and 1 score could be assigned for each of the following symptoms: palpitation,shortness of breath,nosebleed,chest distress,diarrhea,constipation,cyanochroia of the lips,numbness in hands and feet,and dry cough.Results A total of 54 among 67(81%) responders completed the questionnaire,among whom 93% were males and the median age was 36 with the scope from 24 to 55,and 63%(34 respondents) developed AHAS.The univariate analysis showed that the altitude of the responders' original residence(10 score for "<100 m" vs.5.2 score for ">1 000 m",P=0.005),experiences in high altitude areas(10 score for "having not" vs.6.4 score for "having",P=0.039),length of stay in an area over 2 000 m altitude before arrival(9.4 score for "≥3 days" vs.5.7 score for "≤1 day",P=0.011),luggage weight(9.8 score for "≥25 kg" vs.5.5 score for "<25 kg",P=0.002) were correlated with AHAS severity.The multivariate linear regression indicated that the lower altitude of the responders' original residence and the short stay in an area over 2000m altitude before arrival were the factors influencing the severity of AHAS.The linear regression formulation was Y= 2.89-0.187 × the altitude of the responders' original residence(pre 100m) + 2.43 × the length of stay in an area over 2000m altitude before arriving at Yushu(day).Conclusions The past experiences and the pre-arrival preparation are critical factors of AHAS.Measures should be taken to protect the safety and health of responders dispatched to high altitude areas.
引文
1张西洲,陈占诗.人到高原.北京:军事医学科学出版社,1996:93.
2黄庆愿,高钰琪,刘福玉等.急性高原反应相关因素的多元线性回归分析.第三军医大学学报,2006,28(12):1269-1272.
3崔树珍,贾少丽,荆小明,等.空运新兵急性高原病患病率调查.高原医学杂志,1988,2(1):61-63.
4马勇,张西洲,张玉宜,等.30名女青年初入3700米高原地区急性高原反应调查.西北国防医学杂志,2000,21(3):196-197.
5牛文忠,徐敏,蒲永高,等.铁运与空运人员进入高原后高原反应的对比研究.西南国防医药,2007,17(6):822-823.
6高钰琪,黄庆愿,刘福玉,等.促进高原习服措施的研究进展.解放军预防医学杂志,2002,20(4):306.
7田开新,覃军,黄岚,等.急进高原体能变化与急性高原反应关系初探.重庆医学,2006,35(12):1085-1087.
8吕永达.高原医学与生理学.天津:科技翻译出版公司,1995:304-311.
9陈星竹,杨丽云,杨昌菊.入藏旅游者急性高原反应健康教育干预性研究.中国健康教育,2002,18(3):170-172.
10廖巨轮,于国书.习服时间与高原反应600例.铁路建筑技术,2003,中国循证医学杂志2011,11(4):367～371w?w 2w01.c1j中ebm国.o循rg证.cn医学杂志编辑部C?J3E7B1M?地震医疗救援增刊:146.
11尹昭云,谢印芝,牛文忠,等.急性高原反应的诊断和处理原则.解放军预防医学杂志,1997,15(6):395.
12高钰琪,高文祥.高原卫生防护手册.北京:人民军医出版社,2009:59-63.
13 http://www.cdc.gov/niosh/docs/2004-144/chap3.html.
14李维民.进藏卫生指南.北京:军事医学科学出版,1997,p83-84.
15张玉贵,孙梅,唐国清,等.对快速进入高原部队预防急性高原病的措施探讨.临床军医杂志,2009,37(1):41-43.
16田开新,覃军,黄岚,等.急进高原体能变化与急性高原反应关系初探.重庆医学,2006,35(12):1085-1087.
17柴自杰.急性高原反应234例调查分析.临床军医杂志,2008,28(1):50-51.
18 Roach RC,Bartsch P,Hackett PH,et al.e lake louise acute moun-tain sickness scoring system in:lake louise AMS scoring Committee,eds.Hypoxis and mountain medicine.Burlington VT:Queen City Printer.1993:272-274.
19王淼恒,王威,张海峰,等.青藏列车中乘客的高原反应监测与分析.现代预防医.2008,35(9):1704-1707.
2黄庆愿,高钰琪,刘福玉等.急性高原反应相关因素的多元线性回归分析.第三军医大学学报,2006,28(12):1269-1272.
3崔树珍,贾少丽,荆小明,等.空运新兵急性高原病患病率调查.高原医学杂志,1988,2(1):61-63.
4马勇,张西洲,张玉宜,等.30名女青年初入3700米高原地区急性高原反应调查.西北国防医学杂志,2000,21(3):196-197.
5牛文忠,徐敏,蒲永高,等.铁运与空运人员进入高原后高原反应的对比研究.西南国防医药,2007,17(6):822-823.
6高钰琪,黄庆愿,刘福玉,等.促进高原习服措施的研究进展.解放军预防医学杂志,2002,20(4):306.
7田开新,覃军,黄岚,等.急进高原体能变化与急性高原反应关系初探.重庆医学,2006,35(12):1085-1087.
8吕永达.高原医学与生理学.天津:科技翻译出版公司,1995:304-311.
9陈星竹,杨丽云,杨昌菊.入藏旅游者急性高原反应健康教育干预性研究.中国健康教育,2002,18(3):170-172.
10廖巨轮,于国书.习服时间与高原反应600例.铁路建筑技术,2003,中国循证医学杂志2011,11(4):367～371w?w 2w01.c1j中ebm国.o循rg证.cn医学杂志编辑部C?J3E7B1M?地震医疗救援增刊:146.
11尹昭云,谢印芝,牛文忠,等.急性高原反应的诊断和处理原则.解放军预防医学杂志,1997,15(6):395.
12高钰琪,高文祥.高原卫生防护手册.北京:人民军医出版社,2009:59-63.
13 http://www.cdc.gov/niosh/docs/2004-144/chap3.html.
14李维民.进藏卫生指南.北京:军事医学科学出版,1997,p83-84.
15张玉贵,孙梅,唐国清,等.对快速进入高原部队预防急性高原病的措施探讨.临床军医杂志,2009,37(1):41-43.
16田开新,覃军,黄岚,等.急进高原体能变化与急性高原反应关系初探.重庆医学,2006,35(12):1085-1087.
17柴自杰.急性高原反应234例调查分析.临床军医杂志,2008,28(1):50-51.
18 Roach RC,Bartsch P,Hackett PH,et al.e lake louise acute moun-tain sickness scoring system in:lake louise AMS scoring Committee,eds.Hypoxis and mountain medicine.Burlington VT:Queen City Printer.1993:272-274.
19王淼恒,王威,张海峰,等.青藏列车中乘客的高原反应监测与分析.现代预防医.2008,35(9):1704-1707.
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