野外與登山醫學-2014 WMS Practice Guidelines 5 高海拔疾病預防及治療 5

1. 高山病及高海拔腦水腫預防 http://blog.xuite.net/ymmcc/twblog/540135871
2. 高山病及高海拔腦水腫治療 http://blog.xuite.net/ymmcc/twblog/540164931
3. 高海拔肺水腫預防 http://blog.xuite.net/ymmcc/twblog/540171169
4. 高海拔肺水腫治療 http://blog.xuite.net/ymmcc/twblog/540177927
5. 同時罹患HACE及HAPE的治療 http://blog.xuite.net/ymmcc/twblog/540188730

這篇論文最後一節的翻譯了.. 第五節. 同時罹患高海拔腦水腫與高海拔肺水腫如何處置

1. 可使用類固醇 dexamethasone. 劑量比照 HACE, 剛開始先給 8mg. 之後每 6 小時使用 4 mg. 有些HAPE患者可能因為缺氧出血腦部功能異常, 而非腦水腫引起, 但這兩者很難區分, 因此在 HAPE 患者如果出現神經功能異常, 給氧氣改善氧和之後無法恢復, (ataxia運動失調. confusion 困惑.神智混亂, altered mental status 神智改變) 應給予類固醇

2. 在同時罹患HAPE 和HACE 患者可給予 nifedipine 或其他肺血管擴張劑. 但要注意避免降低平均動脈壓 MAP, 因為降低MAP會造成大腦血流不足, 增加腦缺血風險. 

Suggested approach for patients with concurrent HAPE and HACE

Dexamethasone should be added to the treatment regimen of patients with concurrent HAPE and HACE at the doses described above for those with HACE. Some patients with HAPE may have neurologic dysfunction caused by hypoxic encephalopathy rather than true HACE, but making the distinction between hypoxic encephalopathy and HACE in the field can be difficult, and as a result, dexamethasone should be added to the treatment regimen for HAPE patients with neurologic dysfunction that does not resolve rapidly with administration of supplemental oxygen and improvement in the patient’s oxygen saturation. Nifedipine or other pulmonary vasodilators may be used in patients with concurrent HAPE and HACE, but care should be exercised to avoid lowering mean arterial pressure, as this may decrease cerebral perfusion pressure and as a result increase the risk for cerebral ischemia.

最後全文總結

這份指引雖包含很多高海拔疾病的預防及治療策略, 但仍有一些重要的問題需要更多研究來回答. 例如避免高海拔疾病最佳的上升速率, 丹木斯對於 HAPE 的預防及治療, 藥物對於兒童高海拔疾病適當的預防及治療劑量, 高度適應及分次上升 staged ascent 的角色... 

Conclusions

To assist practitioners caring for people planning travel to or already at high altitude, we have provided evidence-based guidelines for prevention and treatment of acute altitude illnesses, including the main prophylactic and therapeutic modalities for AMS, HACE, and HAPE, and recommendations regarding their role in disease management. Although these guidelines cover many of the important issues related to prevention and treatment of altitude illness, several important questions remain to be addressed and should serve as a focus for future research. Such research includes the optimal rate of ascent to prevent altitude illness, the role of acetazolamide in HAPE prevention and treatment, proper dosing regimens for prevention and treatment of altitude illness in the pediatric population, and the role of staged ascent and preacclimatization in altitude illness prevention.