ObjectiveTo investigate the postoperative complications of ex vivo liver resection combined with autologous liver transplantation in the treatment of end-stage hepatic alveolar echinococcosis at high altitude and related prevention and treatment strategies. MethodsSurgical data and follow-up data were collected from 11 patients with end-stage hepatic alveolar echinococcosis who underwent autologous liver transplantation in Qinghai People’s Hospital from January 2013 to March 2019, and intraoperative and postoperative conditions were analyzed. ResultsAll 11 patients underwent autologous liver transplantation successfully, without intraoperative death, among whom 2(18.18%) underwent hemi-extracorporeal hepatectomy and 9 (81.82%) underwent total extracorporeal hepatectomy. For the reconstruction of the retrohepatic inferior vena cava, 2 patients (18.18%) underwent reconstruction with the autologous great saphenous vein, 4 patients (36.36%) underwent reconstruction with artificial vessels, and the autologous retrohepatic inferior vena cava was preserved in 5 patients (45.45%). For biliary reconstruction, 8 patients (72.73%) underwent choledochoenterostomy and 3 (27.27%) underwent choledochocholedochostomy. The main postoperative complications of the 11 patients included bleeding in 2 patients (18.18%), bile leakage and abdominal infection in 4 patients (36.36%), bilioenteric anastomotic stenosis in 1 patient (9.09%), thrombus in 2 patients (1818%), pulmonary infection and pleural effusion in 2 patients (18.18%), and echinococcosis recurrence in 1 patient (9.09%). Of all 11 patients, 2 (18.18%) died during the perioperative period, and the other 9 patients (81.82%) were improved and discharged. Conclusion Bleeding, biliary complications, and infection are the main causes of death in patients undergoing autologous liver transplantation at high altitude. An accurate understanding of surgical indication, careful multidisciplinary evaluation before surgery, superb operation during surgery, standardized surgical procedures, and fine perioperative management are the key to reducing perioperative mortality, avoiding and reducing postoperative complications, and achieving good long-term survival in patients undergoing autologous liver transplantation.

目的探讨中度（Ⅱ级）急性胆囊炎行腹腔镜胆囊切除（LC）中转开腹的危险因素。方法回顾性分析2014年1月至2016年1月137例急性胆囊炎患者资料, 57例患者行LC,80例患者行LC中转开腹,依据手术方式不同分成LC组和中转开腹组。所有数据采用SPSS13.0统计软件进行处理。计量资料以■表示,对各变量进行正态性检验,各变量未通过正态性检验（P＜0.05）,以连续性变量以中位数（四分位间距）表示并做秩和检验。多因素分析采用Logistic回归分析,P＜0.05为差异有统计学意义。结果 （1）单因素分析结果显示:患者年龄、急性胆囊炎发生次数、患者本次发病最高白细胞计数、患者最高体温、彩超诊断下胆囊厚度、胆囊大小中转开腹组均显著高于LC组（P＜0.05）,LC医师年资中转开腹组均显著低于LC组（P＜0.05）。（2）多因素分析结果显示:急性胆囊炎发生次数,患者本次发病最高体温是中转开腹的独立危险因素,LC医师年资是中转开腹的独立保护因素。结论急性胆囊炎发生次数、患者体温是中度（Ⅱ级）急性胆囊炎行LC中转开腹独立危险因素,有经验的手术医师可以减少该类疾病中转开腹的概率。

近年来，胰腺癌的治疗并未取得良好的收效，全基因组测序及诊断的微解剖技术使我们发现胰腺癌的分子分型的多样性，诊疗策略均无法套用其他肿瘤的模式，但可以肯定的是由于胰腺癌肿瘤组织和间质的部分独立性发展及相互联系制约，使得肿瘤相关的微血管以及肿瘤微环境亦有其独特性，肿瘤微环境更像是一个微生态，干预微血管的生理可以使肿瘤、微环境的特性发生改变，机械性的过渡干预或者不适时的干预则会干扰了机体自身对肿瘤的免疫。目前针对胰腺癌微血管的生理特性的认识较前有所提高，但其对肿瘤发生、发展及转移的影响机制仍需要进一步研究。

目的 探讨手术室量化评估干预策略对胃肠道肿瘤手术患者应激反应和术后康复的影响.方法 选择200例行胃肠道肿瘤手术患者,采用随机数字表法分为观察组100例和对照组100例.对照组患者接受常规干预,观察组患者接受手术室量化评估干预.采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评估两组患者的心理应激状态,并比较两组患者手术前后的心理应激状态评分及躯体应激反应指标[血清内皮素(ET)、一氧化氮(NO)、C反应蛋白(CRP)、白细胞介素-6(IL-6)]水平、手术时间、术后康复效果及护理满意度.结果 术后,观察组患者的SAS、SDS评分及ET、NO、CRP、IL-6水平均低于对照组(P﹤0.05);手术时间及术后首次排气时间、首次排便时间、首次下床时间、总住院时间均明显短于对照组(P﹤0.01);观察组患者及医师对手术室护理工作的满意度均明显高于对照组(P﹤0.01).结论 与常规干预比较,对胃肠道肿瘤患者实施手术室量化评估干预,可改善护理质量,减轻患者的心理应激状态和躯体应激反应,有利于患者术后康复,值得临床推广.

目的:探讨肝切除手术治疗肝包虫病的疗效及对患者预后和肝功能的影响.方法:选取2015年2月-2018年5月期间我院收治的肝包虫病患者103例为研究对象,所有患者根据手术方式的不同分为A组(n=51,行外膜内完整外囊摘除术)和B组(n=52,行肝切除手术),比较两组患者围术期临床指标、肝功能指标、并发症发生情况,随访半年,记录两组患者随访期间死亡及原位复发情况.结果:B组术中出血量少于A组,手术时间、术后拔管时间以及住院时间均短于A组,组间比较差异有统计学意义(P＜0.05).与术前比较,两组患者术后3d、术后7d谷丙转氨酶、胆红素以及谷草转氨酶均升高,但B组低于A组(P＜0.05);与术前比较,两组患者术后3d、术后7d白蛋白降低,但B组高于A组(P＜0.05);与术后3d比较,两组患者术后7d谷丙转氨酶、胆红素以及谷草转氨酶均降低,白蛋白升高(P＜0.05).B组术后并发症总发生率为7.69％(4/52),低于A组的23.52％(12/51),组间比较差异有统计学意义(P＜0.05).两组随访期间无患者死亡,原位复发率比较差异均无统计学意义(P＞0.05).结论:肝切除手术治疗肝包虫病患者安全有效,可减少术中出血量,促进患者术后康复,减轻手术对肝功能的影响,且术后复发率较低,患者预后较好.

回顾分析2013年1月至2014年1月青海省人民医院普外科行体外肝切除加自体肝移植治疗4例终末期肝泡型包虫病患者资料。4例患者顺利完成手术，无肝期190～250 min，体外病灶切除及自体门静脉重建肝静脉流出道耗时120～150 min。其中1例术后出现多脏器功能衰竭于术后第4天死亡，其余3例随访情况良好。

Objective: To evaluate the therapeutic evaluation of four different surgical treatments for postoperative biliary leakage in patients with hepatic hydatid disease. Methods: A total of 103 cases of hepatic hydatid disease, who were admitted to Qinghai Provincial People's Hospital from December 2015 to June 2017, were selected and divided into group A (undergoing endocystectomy, n=26), group B (undergoing complete cystectomy, n=28), group C (external capsule for subtotal resection, n=25) and group D (undergoing partial hepatectomy, n=24) according to different surgical methods. The operation time, intraoperative blood loss, postoperative tube time and hospitalization time were compared among the four groups. The incidence and complications of bile leakage after operation in the four groups were compared and analyzed. Results: There were significant differences in the operation time, intraoperative blood loss, postoperative tube time and hospitalization time among the four groups (P＜0.05). The operation time and the amount of bleeding during operation in group A were significantly less than those in group B, C and D; the operation time and the amount of bleeding in group B and group C were significantly less than those in group D (P＜0.05). The postoperative tube time of group A was significantly more than that of group B, C and D; the postoperative tube time of group D was significantly more than that of group B and group C (P＜0.05). The hospitalization time of group D was significantly more than that of group A, B and C; the hospitalization time of group A was more than that of group B and group C (P＜0.05). The incidence of postoperative bile leakage in group A was significantly higher than that in group B, C and D (P＜0.05). There were no statistically significant differences in the incidence of diaphragmatic infection and pleural effusion among the four groups (P＞0.05). The incidence of residual cavity infection and residual cavity effusion in group A was higher than that in group B, C and D (P＜0.05). The incidence of postoperative liver function impairment in group D was significantly higher than that in group A, B and C (P＜0.05). Conclusion: Surgical treatment is the main way to treat hepatic hydatid disease, each of the four operation methods has advantages and disadvantages, and the most suitable surgical method should be selected according to the actual situation of the patient.

AIM:Recently, many reports showed that the pretransplant neutrophil-lymphocyte ratio (NLR) may be correlated with the prognosis of patients undergoing liver transplantation (LT) for hepatocellular cancer (HCC). However, their results still remained controversial. Thus we performed a meta-analysis of 13 studies to estimate the prognostic value of pretransplant NLR.METHODS:Databases including PubMed, Embase, Cochrane Library and Web of Science were searched to September 2017. Hazard ratio (HR) or odds ratio (OR) with its 95% CI was used to evaluate the association between elevated NLR and the prognosis or clinical features of liver cancer patients.RESULTS:A total of 13 studies including 1936 patients were included in this meta-analysis. Elevated pretransplant NLR had a close association with the overall survival (HR: 2.22; 95% CI: 1.34-3.68), recurrence-free survival (HR: 3.77; 95% CI: 2.01-7.06) and disease-free survival (HR: 2.51; 95% CI: 1.22-5.15) of patients undergoing LT for HCC, respectively. In addition, elevated NLR was associated with the presence of vascular invasion (OR: 2.39; 95% CI: 1.20-4.77) and Milan criteria (OR: 0.26; 95% CI: 0.17-0.40).CONCLUSION:The results of this meta-analysis showed that elevated pretransplant NLR may be used as a new prognostic predictor after LT for HCC.

目的 发现西宁地区胆总管结石并发胰腺炎的临床特点,提高预见性的诊疗水平.方法 收集2011年1月至2014年12月间就诊于青海省人民医院的胆总管结石患者457例,其中合并急性胰腺炎患者198例,设为试验组;单纯胆管结石患者259例,设为对照组.统计试验组与对照组患者年龄、性别与体重指数,入院3 d内的生化、凝血功能、全血细胞分析、血气分析、腹部核磁或CT等结果,分析合并胆囊结石与胆管炎的情况以及胰腺炎与糖尿病病史对患者的影响.采用多因素分析法对影响胆总管结石患者并发胰腺炎的因素进行统计分析.结果 试验组与对照组患者在年龄(P=0.143)、性别(P=0.065)、体重指数(P=0.071)、C-反应蛋白(P=0.208)、结石直径(P=0.600)、与糖尿病病史(P=0.306)各方面无明显差异(均P>0.05).与对照组相比,试验组胆总管直径明显偏大(P=0.004),合并胆囊结石(χ2=15.847,P<0.001)及胆管炎(χ2=63.820,P<0.001)的病例明显更多,具有胰腺炎病史(χ2=15.925,P=0.015)者更多;且γ-谷氨酰基转移酶含量更高(P<0.001)、氧分压更低(P<0.001).多因素分析结果表明,胆总管直径、合并胆囊结石、合并胆管炎、胰腺炎病史、γ-谷氨酰基转移酶、氧分压对胆总管结石患者并发胰腺炎有明显影响,且各因素的影响程度从大到小依次为合并胆管炎、合并胆囊结石、有胰腺炎病史、氧分压、胆总管直径以及γ-谷氨酰基转移酶.结论 西宁地区胆总管结石并发胰腺炎的临床特点为:γ-谷氨酰基转移酶升高、胆总管直径增加、氧分压降低、易发胆囊结石与胆管炎,具有胰腺炎病史.根据上述临床特点有助于对胆总管结石并发胰腺炎进行预见性治疗.

Objective To analyze common postoperative complications after autologous liver transplantation in patients diagnosed with hepatic alveolar echinococcosis (HAE)from plateau area. Methods Clinical data of 6 patients with advanced HAE undergoing ex-situ or partially ex-situ hepatectomy combined with autologous liver transplantation were retrospectively analyzed. Clinical characteristics of postoperative complications were analyzed. Results Postoperative complications mainly included biliary tract complications (n=4),intra-abdominal hemorrhage (n=1 ),infection (n=3). Two cases presented with bile leakage complicated with intra-abdominal infection and died from infectious shock and multiple organ dysfunction syndrome. One patient had intra-abdominal hemorrhage and died from hemorrhagic shock and disseminated inravascular coagulation. Biliary tract complication and intra-abdominal hemorrhage were primary causes of mortality. Conclusions Biliary tract complication,intra-abdominal hemorrhage and infection are the main prognostic factors for HAE patients undergoing autologous liver transplantation.

Objective To investigate the extent of pancreatic and liver function damage of acute necrotizing pancreatitis (ANP) rats under altitude hypoxia environment,and to provide a reference for better diagnosis and treatment of severe acute pancreatitis (SAP) in the plateau region.Methods Ninety-six specific pathogen free (SPF) Wistar male rats were involved in 1 500 meters,3 300 meters and 4 300 meters altitude.The model of ANP was established by using pancreatic capsule injection of sodium taurocholate (NaTc).In the sham operation group,the rats' belly was opened and closed after only flipping its pancreas several times.Rats in sham group were sacrificed at 6 h,and ANP group were sacrificed at 6,12,24 h after modeling.Serum amylase activity was measured,and pancreas and liver tissue were harvested for pathological examination and score.Results Serum amylase activity in sham operation group rats was not remarkably changed,and pathological changes of pancreas and liver were not obvious.At same altitude,serum amylase activity,pancreas and liver pathology score of ANP rats at each time point were significantly higher than those in the sham operation group;and serum amylase activity,pancreas and liver pathology scores of ANP 12,24 h group rats were significantly higher than those of ANP 6h group;and the difference was statistically significant (P ＜ 0.05).At 3 300 meters,4 300 meters altitude,the pancreas and liver pathology scores of ANP rats at each time point were significantly higher than those at 1 500 meters altitude,and the differences were statistically significant (P ＜ 0.05),but the difference in serum amylase activity was not statistically significant.Conclusions With the increase of altitude,pancreatic and liver pathological damage of ANP rats shows continuing aggravation.

Objective To explore the expression of matrix metalloproteinase-11 (MMP-11) gene in gastric cancer and its correlation with transcription factor Sp1.Methods The expressions of the MMP-11 and Sp1 in level of RNA and protein in 11 specimens from the gastric cancer patients s were detected by RT-PCR,differential PCR and Western-blot,respectively.Results Electrophoresis illustration showed MMP-11 mRNA expression had significant differences in eight pairs of gastric cancer tissues and normal tissues,including 7 pairs of over expressed in gastric cancer tissues and low or no expression in normal tissues,and 1 pair of low expression in cancer tissues but high in normal tissues.The relative molecular weight of Sp1 protein was mainly 95×103 in cancer tissue and 106×103 in normal tissues.Activated MMP-11 protein mainly was over expressed in gastric cancer tissues,and low or no expression in normal tissues,but degradable MMP-1 1 protein was not observed.The enzyme prototype of and activated type of MMP-11 protein were also associated with Sp1 protein.Conclusions The MMP-11 mRNA expression in gastric tissue is higher than that in the adjacent tissues.Sp1 protein and MMP-11 protein are expressed in gastric cancer,but are low or no expression in normal tissue.There is relationship between Spl and MMP-11.

青海省是肝包虫病的高发地区,其中泡型肝包虫病的发病更位居全国首位.终末期泡型肝包虫病的治疗极为困难,常规手术无法达到根治的目的.体外肝切除结合自体肝移植不失为治疗该病的一种理想选择.我院于2013年5月22日,对1例常规肝切除方法无法治疗的终末期泡型肝包虫病患者,实施了体外肝切除+自体肝移植术,效果满意.现报告如下。

急性胰腺炎(AP)是一种发病率和死亡率较高的暴发性疾病.最常见的致病因素是胆结石和酗酒,大多患者由于并发症的出现需长期住院治疗和进入重症监护室(ICU)治疗.通常情况下,急性胰腺炎的初始治疗包括禁食疗法(NPO)、镇痛药的使用和充足的静脉补液.对于几天内不能接受正常食物的病人来讲,营养支持是必需的；有大量的科学证据表明肠内营养优于全肠外营养(TPN).肠内营养保护肠道黏膜完整性并防止细菌在肠道内过度生长.肠内营养明显减少了感染的风险、降低了手术干预的需要,并缩短了住院的时间.

OBJECTIVE:To explore the relationship between systemic inflammatory response syndrome(SIRS) and severity of acute pancreatitis combined with plateau erythrocythemia in the high altitude.METHODS:A retrospective analysis on the clinical data which involved acute pancreatitis combined with plateau erythrocythemia (n = 40) and without plateau erythrocythemia (n = 40) admitted from September 2006 to September 2009 was conducted. According to the unified standards, these cases were divided into plateau erythrocythemia group and no plateau erythrocythemia group. The patients in plateau erythrocythemia group were further divided into severe group and mild group according to scores of APACHEII. The data was analyzed according to the patient with (or without) SIRS, SIRS's standard indicators, diagnostic parameter and relation of severity and duration of SIRS in acute pancreatitis combined with plateau erythrocythemia.RESULTS:There was significantly discrepancy between plateau erythrocythemia group and no plateau erythrocythemia group not only in the incidence of patients who developed SIRS, but also in two items of patients fulfilling or not fulfilling diagnostic criteria of SIRS (P < 0.05). There was significant statistical difference in three items of diagnostic parameter of SIRS between plateau erythrocythemia group and no plateau erythrocythemia group (P < 0.05). Significant difference in two and three diagnostic parameter was found on severity of SIRS in acute pancreatitis combined with plateau erythrocythemia (P < 0.05). The more severity acute pancreatitis combined with plateau erythrocythemia was, the longer duration of SIRS was.CONCLUSION:SIRS is highly correlated with the severity of SIRS in acute pancreatitis combined with plateau erythrocythemia in the high altitude.

有关不同海拔高度重症急性胰腺炎(SAP)并发急性肾功能损害时肾脏病理改变的报道甚少,我们对不同海拔高度SAP大鼠不同病程阶段肾脏病理改变进行了观察,并测定了肾功能,以探讨高原低氧环境对SAP肾脏损害的影响.

OBJECTIVE To explore characteristics of the pathogenesis and progression of the acute pancreatitis (AP) in high altitude and the relationship between AP and plateau erythrocythemia. METHODS Retrospective analysis of the clinical data of AP was conducted for 103 inpatients who were admitted during 2003 and 2005 to the People's Hospital of Qinghai Province, including 12 cases of AP complicated with plateau erythrocythemia and 91 cases of AP no complicating plateau erythrocythemia. The patients were divided into a group of 57 cases living in high altitude (>3 000 m) and 46 patients in lower altitude group (<2 200 m). Clinical data of the patients were collected at admission, and liver, kidney and lung functions were determined for all patients. RESULTS Alanine aminotransferase (ALT) and creatinine (Cr) were significantly higher in AP complicating plateau erythrocythemia compared with AP patients without complicating plateau erythrocythemia [ALT: (160.70 + or - 19.14) U/L vs. (78.00 + or - 14.96) U/L, Cr: (135.45 + or - 11.99) micromol/L vs. (91.42 + or - 17.08) micromol/L, both P<0.05]. Arterial partial pressure of oxygen (PaO(2)) and arterial oxygen saturation (SaO(2)) were significantly lower in AP with complication of plateau erythrocythemia than in AP without complicating plateau erythrocythemia [PaO(2): (45.10 + or - 0.40) mm Hg vs. (65.48 + or - 1.36) mm Hg, 1 mm Hg=0.133 kPa, SaO(2): 0.851 + or - 0.004 vs. 0.940 + or - 0.009, both P<0.05]. There was no difference in aspartate aminotransferase (AST), blood urea nitrogen (BUN) and arterial partial pressure of carbon dioxide (PaCO(2)), however, their levels were higher in plateau erythrocythemia cases than those without plateau erythrocythemia [AST: (87.35 + or - 8.10) U/L vs. (83.00 + or - 18.61) U/L, BUN:(10.90 + or - 0.97) mmol/L vs. (7.37 + or - 0.98) mmol/L, PaCO(2): (33.20 + or - 0.31) mm Hg vs. (25.32 + or - 1.14) mm Hg , all P>0.05]. ALT and Cr were significantly higher in high altitude cases than those in lower altitude cases [ALT: (126.92 + or - 15.46) U/L vs. (86.00 + or - 10.23) U/L, Cr:(126.10 + or - 10.01)micromol/L vs. (101.84 + or - 5.46) micromol/L, both P<0.05]. There was no difference in AST, BUN and PaCO(2), however, the values were slightly higher in high altitude cases compared with lower altitude cases [AST: (98.70 + or - 8.10) U/L vs. (93.14 + or - 21.46) U/L, BUN: (8.15 + or - 1.00) mmol/L vs. (5.86 + or - 0.40) mmol/L, PaCO(2): (32.32 + or - 1.01) mm Hg vs. (30.12 + or - 2.76) mm Hg, all P>0.05]. There was no difference in PaO(2) and SaO(2), however, it was slightly lower in high altitude cases than lower altitude cases [PaO(2): (58.80 + or - 1.20) mm Hg vs. (66.86 + or - 3.20) mm Hg, SaO(2): 0.910 + or - 0.011 vs. 0.930 + or - 0.008, both P>0.05]. CONCLUSION The results showed that the deterioration of hepatic, kidney and lung function in AP patients living in the plateau was related to high altitude and erythrocythemia.

Objective To investigate the expression and changes of the concentration of MMP-9 in the serum of the severe acute pancreatitis(SAP)patient who live in the high altitude,and to explore clinical significance.Methods Using ELISA to detect the level of the concentration of MMP-9 in the serum of people of the SAP(36 cases) and healthy persons(39cases).Results The concentration of MMP-9 showed significant increase in values(P<0.05) on the SAP patient,namely it was 12.56±3.00 ng/mol and in health group was 3.49±0.63 ng/mol,respectively.MMP-9 in SAP complicated with lung injury showed obvious changes than that of no complication of lung injury(P<0.05).The values were 13.60±2.78 ng/mol and 10.09±1.94 ng/mol,respectively.Conclusion The results showed that the concentration of MMP-9 have significant changes in the serum of the SAP patient in the high altitude.It means that it may involve in the process of the SAP and closely relate with lung injury in SAP.

Objective:To estimate the feature of diagnosis and treatment for early disseminated intravascular coagulation(DIC) after severe traumas with at high altitude.Methods:The laboratory indices including prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FBG),D-Dimer(D-D),and platelet(PLT) were measured and assessed for 20 patients with DIC.And acute physiological,chronic health evaluationⅡ(APACHEⅡ) and numbers of failure organ were conducted with an available treatment.Results:All 20 patients had abnormal indices of DIC on first day after severe trauma and over two failure organs.14 of 20 cases were survived(survival group) and 6 died(death group).There is no difference between both group for APACHEⅡ and numbers of failure organ(P>0.05).After day 7 treatment,level of PLT and FBG decreased greatly,D-D、 PT、APTT increased significantly in death group;5 cases of survival group had only abnormal PLT、D-D、FBG、PT、APTT,and there is a significant difference between two groups(P<0.05).Moreover,APACHEⅡ decreased to 17.6±5.7 in survival group and 28.6±6.1 in death group(P<0.01);more 4 organs occurred failure in the death group but 3 failure organs in 5 cases of survival group(P<0.05).Conclusions:Severe traumas are ease to be complicated with DIC at high altitude.Treatment of primary disease,in support of organ function,added coagulation factor,early use of small molecule heparin are active and key way for patients with severe trauma complicated with DIC.

Objective To explore the risk factors and therapeutic strategies for severe multi-trauma complicated with mul-tiple organ dysfuncfion syndrome(MODS)at high altitudes.Methods Patients included 93 cases(group A)and 98 cases(group B) with severe trauma admitted from January 2003 to December 2004 and from January 2005 to December 2007,respectively.Age,gender,acute physiology and chronic healthy score(APACHE Ⅱ),injury severity score(ISS),hypoxia.shock,sepsis,co-aggulation disorders,abdomen compartment syndrome (ACS),blood glucose were analyzed for both groups using logistic analysis.Risk factors affecting the mortality of severe trauma in terms of treatment were analyzed.Results 45(45/93)cases in group A and 48(48/98)cases in group B were complicated with MODS in early stage.The conditions were more severe in patients with MODS than those in patients without MODS with regard to shock,hypoxia,ACS,coagulalion disorders,APACHE Ⅱ,ISS.and the difference were significant(P<0.01).The mortality in group B was lower than that in group A beeause of improved thera-peutic stregies including CBP,appropriate management of shock,corrective coagulation disorders,target glucose control, full sedation analgesia,inhibiting inflammation,ventilation and sufficient liquid resuscitation,the difference was significant(P<0.01).Logistic multiple regression analysis showed that all of risk factors were higher than in the patients of shock,hypoxia,septic shoek Cpmclusion Shock,hypoxia,sepsis and strategy of clinical treatment are coralated with multi-trauma complicated with MODS in eady stage high altitudes.Correcting hypoxia,shock and coagulation disorders,sufficient fluid resuscitation,target glucose control,full sedation analgesia,and inhibiting inflammation are the crux of preventing MODS in early multi-trauma pa-tients.