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.
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。
Objective To explore the clinical features, treatment measures, disease outcomes, and differences in patients with asthma admitted to hospitals in Qinghai and Tibetan Plateau, and further analyze the risk factors. Methods A retrospective analysis was conducted on the clinical data of 297 patients with asthma admitted to Qinghai Provincial People’s Hospital and Tibet Autonomous Region People’s Hospital from 2015 to 2021. A standardized case report form (CRF) was designed and used to collect patients’ general information, International Classification of Diseases (ICD-10), clinical symptoms, treatment, laboratory examination, and pulmonary function test data. The clinical features of the patients were described, and the risk factors of the clinical features of asthma patients admitted to hospitals in Qinghai and Tibetan Plateau were analyzed by using a stepwise Logistic regression model. Results A total of 297 patients with asthma admitted to hospitals in Qinghai and Tibetan Plateau were included in this study. The overall pulmonary function of asthma patients admitted to hospitals in Qinghai was worse than that in Tibetan Plateau (FEV1/FVC%: 73.22±13.59 vs. 80.70±18.36, P<0.001; TLC: 101.50 vs. 163.00, P=0.001). The incidence of related clinical symptoms in asthma patients admitted to hospitals in Qinghai were higher than those in Tibetan Plateau (dyspnea: 98.0% vs. 66.0%, P<0.001; cyanosis: 82.0% vs. 34.0%, P<0.001; pulmonary rales: 80.7% vs. 70.7%, P=0.046). There was no significant difference in treatment measures between patients in Qinghai and Tibetan Plateau (P>0.05). The main factors contributing to the differences in clinical characteristics between the two regions were the altitude of residence (OR=0.94, 95%CI: 0.91-0.98, P=0.004) and the co-existence of allergic diseases (OR=9.47, 95%CI: 2.68-3347.07, P=0.012).ConclusionsCompared with Tibet, the incidence of asthma symptoms and poorer lung function were higher among inpatients with asthma in Qinghai; there was no significant difference in treatment measures between the two regions, but there was a significant difference in prognosis; the main factors contributing to the differences in clinical characteristics between the two regions were the altitude of residence and the co-existence of allergic diseases.
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 “lt;100 m” vs. 5.2 score for “gt;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 “lt;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.