寫在前面:
為了方便非醫療背景的民眾閱讀, acetazolamide 一律稱為丹木斯, 雖然丹木斯這個商品目前台灣已經買不到了, 但這個藥物很多登山者都聽過, 方便記憶. 你也可以直接記英文學名acetazolamide , 或記中文學名"乙醯胺基硫唑嘧錠", 至於類固醇 Dexamethasone, 雖然類固醇種類繁多, 也不僅是 Dexamethasone 能預防或治療AMS/HACE, 但為了方便閱讀, 底下所有提到的類固醇通通指 Dexamethasone. 至於 phosphodiesterase inhibitor 一律以威而鋼/犀利士代替.
高海拔環境讓旅遊者暴露於寒冷、低濕度、紫外線增加，還有較低的氣壓，這些因子都會造成問題。而最大的問題應該在於低氧。舉例來說，在3000公尺的海拔，呼吸攝入的氧氣分壓大概是海平面高度的69%。缺氧問題的嚴重程度取決於海拔、上升速率、還有暴露時間長短。在高海拔睡覺最容易造成低血氧。如果1天上升到高海拔並當天下降到低海拔，對於身體來說是最沒有影響的。典型的高海拔景點包括，祕魯庫斯科 Cusco (11,000 ft; 3,300 m), 玻利維亞首都拉巴斯La Paz (12,000 ft; 3,640 m), 西藏拉薩 Lhasa (12,100 ft; 3,650 m), 聖母峰基地營 Everest Base Camp (17,700 ft; 5,400 m), 和非洲吉力馬札羅 Kilimanjaro (19,341 ft; 5,895 m)。
人類身體對於適應低氧環境是很好的，只是需要時間的調適(可參考Box 2-03)。人類在高海拔環境會感到不舒服，會需要3-5天的進程。也因此，在上升到更高海拔之前，在2500-2750公尺適應個幾天是較理想的做法。適應高度可以預防高海拔病，增加睡眠品質。雖然跟在低海拔比，自己的體能表現會下降，但適應高度會讓你在高海拔過的較舒適。增加換氣量是影響高度適應的最重要因子，應避免使用會影響呼吸的藥物，增加紅血球製造力不影響急性適應。
Altitude Illness
Peter H. Hackett, David R. Shlim
The high-altitude environment exposes travelers to cold, low humidity, increased ultraviolet radiation, and decreased air pressure, all of which can cause problems. The biggest concern, however, is hypoxia. At 10,000 ft (3,000 m), for example, the inspired PO2 is only 69% of sea-level value. The magnitude of hypoxic stress depends on altitude, rate of ascent, and duration of exposure. Sleeping at high altitude produces the most hypoxemia; day trips to high altitude with return to low altitude are much less stressful on the body. Typical high-altitude destinations include Cusco (11,000 ft; 3,300 m), La Paz (12,000 ft; 3,640 m), Lhasa (12,100 ft; 3,650 m), Everest Base Camp (17,700 ft; 5,400 m), and Kilimanjaro (19,341 ft; 5,895 m). The human body adjusts very well to moderate hypoxia, but requires time to do so (Box 2-03). The process of acute acclimatization to high altitude takes 3–5 days; therefore, acclimatizing for
a few days at 8,000–9,000 ft (2,500– 2,750 m) before proceeding to a higher altitude is ideal. Acclimatization prevents altitude illness, improves sleep, and increases comfort and well-being, although exercise performance will always be reduced compared with low altitude. Increase in ventilation is the most important factor in acute acclimatization; therefore, respiratory depressants must be avoided. Increased red-cell production does not play a role in acute acclimatization.
對旅遊者的風險
無法良好適應的人，在2500m以上，甚至是較低的高度，可能會造成高海拔病。容不容易有高海拔不良反應是由基因決定的，然後也沒有一種簡單的篩檢方式來預測它的風險。訓練或體適能不會影響高海拔病的風險。小朋友得到高海拔病的風險跟大人是差不多的。50歲以上的人風險較低。如果要去的地方的海拔跟上升速度差不多，先前對該海拔的反應是最可以信任的參考，但不一定準。在特定的基礎感受性之下比較，海拔、上升速率、體力花費對於風險高低影響很大。要制定出一個可以避免高海拔病的行程是很困難的一件事，因為各人疾病敏感度不同、地形不同，旅行開始的地點也不同。旅行者的目標不是避免所有高海拔症狀，而是安排一個頂多罹患輕微高海拔疾病的行程。
RISK FOR TRAVELERS
Inadequate acclimatization may lead to altitude illness in any traveler going to 8,000 ft (2,500 m) or higher, and sometimes even at lower altitude. Susceptibility and resistance to altitude illness are genetic traits, and no simple screening tests are available to predict risk. Risk is not affected
by training or physical fitness. Children are equally susceptible as adults; people aged >50 years have slightly lower risk. How a traveler has responded to high altitude previously is the most reliable guide for future trips if the altitude and rate of ascent are similar, but this is not infallible. Given certain baseline susceptibility, risk is largely influenced by the altitude, rate of ascent, and exertion (see Table 2-07). Creating an itinerary that will avoid any occurrence of altitude illness is difficult because of variations in individual susceptibility, as well as in starting points and terrain. The goal for the traveler may not be to avoid all symptoms of altitude illness but to have no more than mild illness.
剛剛提到的一些地方，常需要搭飛機很快的上升到超過3400m的海拔，這樣子旅行者就馬上處在一個高風險的狀況。藥物預防對於這些旅行者是必須的，在海拔提升前還要花 2-4 天作高度適應。有些地方像是Cuzco和La Paz，登山客可以到達機場後，先去海拔比機場還低一些的地方去睡覺。
Some common destinations such as the ones mentioned above require rapid ascent by airplane to >3,400 meters and thus place travelers in the high-risk category (see Table 2-07). Chemoprophylaxis may be necessary for these travelers, in addition to 2–4 days of acclimatization before going higher. In some cases, such as Cuzco and La Paz, the traveler can descend to altitudes much lower than the airport to sleep.
臨床表徵
高海拔疾病主要可以分成三種症狀: 急性高山病[acute mountain sickness (AMS)],高海拔腦水腫[high-altitude cerebral edema (HACE)],和高海拔肺水腫[high-altitude pulmonary edema (HAPE)]
CLINICAL PRESENTATION
Altitude illness is divided into 3 syndromes: acute mountain sickness (AMS), high-altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE).
急性高山病[acute mountain sickness (AMS)]
AMS是高海拔病中最常見的一個形式，舉例來說，去科羅拉多州旅遊, 睡超過海拔2500m以上的遊客有 25% 會得到AMS。AMS的症狀很像是宿醉者。頭痛是主要的症狀，另外有時也會伴隨疲累、食慾不振、噁心、嘔吐。頭痛發作通常是到較高海拔後2–12小時內，通常是在第一晚或隔天發生。還沒學會說話的小孩子可能出現食物不振、躁動或臉色蒼白。AMS通常會在有良好適應後12-48小時內有所改善。
Acute Mountain Sickness
AMS is the most common form of altitude illness, affecting, for example, 25% of all visitors sleeping above 8,000 ft (2,500 m) in Colorado. Symptoms are similar to those of an alcohol hangover: headache is the cardinal symptom, sometimes accompanied by fatigue, loss of appetite, nausea, and occasionally vomiting. Headache onset is usually 2–12 hours after arrival at a higher altitude and often during or after the first night. Preverbal children may develop loss of
appetite, irritability, and pallor. AMS generally resolves with 12–48 hours of acclimatization.
高海拔腦水腫[high-altitude cerebral edema (HACE)]
HACE 是嚴重進展的AMS，罕見，它常與高海拔肺水腫HAPE 相關。除了AMS的症狀外，會極度的昏睡，也會嗜睡、神智混亂，直線測試tandem gait test會運動失調，很像是一個喝醉的人。罹患HACE 的人需要立即下降高度。如果沒有做，病人開始運動失調的24小時內會死亡。多提一句，沒有黃金時間，隨時會死。
High-Altitude Cerebral Edema
HACE is a severe progression of AMS and is rare; it is most often associated with HAPE. In addition to AMS symptoms, lethargy becomes profound, with drowsiness, confusion, and ataxia on tandem gait test, similar to alcohol intoxication. A person with HACE requires immediate descent; death can ensue within 24 hours of developing ataxia, if the person fails to descend.
高海拔肺水腫[high-altitude pulmonary edema (HAPE)]
HAPE 可以單獨發生，也可以伴隨AMS或HACE 一起發生。發生機率來說，去Colorado滑雪的人，HAPE發生率是每10000位有1位；而海拔提高到4270m的登山者，每100位中有1位會罹患HAPE。一開始的症狀是運動時會逐漸呼吸困難，合併無力和咳嗽，到最後是在休息時越來越呼吸困難。當肺水腫發生時，氧氣或下降高度可以保命。高海拔肺水腫會比高海拔腦水腫更快速致死。
（致死率應該是腦水腫比較高，但盛行率是肺水腫比較大，所以肺水腫死亡人數會更多。）
High-Altitude Pulmonary Edema
HAPE can occur by itself or in conjunction with AMS and HACE; incidence is 1 per 10,000 skiers in Colorado and up to 1 per 100 climbers at more than 14,000 ft (4,270 m). Initial symptoms are increased breathlessness with exertion, and eventually increased breathlessness at rest, associated with weakness and cough. Oxygen or descent is life-saving. HAPE can be more rapidly fatal than HACE.
過去病史
登山客有包括心臟病、心臟缺血（心絞痛)、鐮刀型貧血、任何形式的肺部疾病(有缺氧的病史)、睡眠呼吸中止症等過去病史，在上山前先要去諮詢有在專門處理高海拔疾病的醫師。在高海拔環境，對先前健康的旅行者而言，發生新的缺血性心臟病心肌缺氧問題的風險並不會升高。有著氣喘、高血壓、心律不整、癲癇等問題的病人，在低海拔環境控制良好的話，在高海拔環境是不會有甚麼特別問題。那有睡眠呼吸中止症的病人會建議要服用acetazolamide。
有這輕度到中度睡眠呼吸中止症的病人上高海拔是不用攜帶CPAP machine的；有嚴重睡眠呼吸中止症的病人應避免高海拔旅行，除非攜帶CPAP機器加上氧氣輔助治療。糖尿病患者上高海拔地區是沒有甚麼問題，但患者平常要習慣運動，隨時小心監測血糖。Diabetic ketoacidosis可能會被高海拔疾病誘發，服用acetazolamide後會更難治療。並非所有血糖機在高海拔都可以得到準確數值。
大多數的人在高海拔環境，不會有視力問題。但有些人如果有做過 radial
keratotomy(放射狀角膜切開術)，日後在高海拔環境下，可能會發展成急性遠視，這會讓他們沒辦法照顧自己。
LASIK和其他新的手術在高海拔只會造成輕微的視覺干擾。
Preexisting Medical Problems
Travelers with medical conditions, such as heart failure, myocardial ischemia (angina), sickle cell disease, any form of pulmonary insufficiency or preexisting hypoxemia, or obstructive sleep apnea (OSA) should consult a physician familiar with high-altitude medical issues before undertaking high-altitude travel (see Table 2-08). The risk for new ischemic heart disease in previously healthy travelers does not appear to be increased at high altitudes. Patients with asthma, hypertension, atrial arrhythmia, and seizure disorders that are well controlled at low altitude generally do well at high altitude. All patients with OSA should receive acetazolamide; those with mild to moderate OSA may do well without their CPAP machines, while those with severe OSA should avoid altitude travel unless given supplemental oxygen in addition to their CPAP. People with diabetes can travel safely to high altitudes, but they must be accustomed to exercise and carefully monitor their blood glucose. Diabetic ketoacidosis may be triggered by altitude illness and may be more difficult to treat in those on acetazolamide. Not all glucose meters read accurately at high altitudes.
Most people do not have visual problems at high altitudes. However, at very high altitudes some people who have had radial keratotomy may develop acute farsightedness and be unable to care for themselves. LASIK and other newer procedures may produce only minor visual disturbances at high altitudes.
孕婦短暫至高海拔旅行，對於胎兒的傷害，目前尚未有研究或案例報告。但謹慎來說，還是會建議孕婦的睡眠海拔不要超過3048m。另外也要確定此次懷孕屬於低風險，且孕婦本身都是健康的。應該與孕婦討論，在偏遠地區或山區，遇到懷孕併發症的危險性。
備註：海拔均指睡眠海拔
There are no studies or case reports of harm to a fetus if the mother travels briefly to high altitudes during pregnancy. However, it may be prudent to recommend that pregnant women do not stay at sleeping altitudes higher than 10,000 ft (3,048 m). In addition, the pregnancy should be verified as low risk and the mother in good health. The dangers of having a pregnancy complication in remote, mountainous terrain should also be discussed.
Table 2-07.急性高海拔病的風險評估 (*備註: 所有海拔上升均指睡眠海拔)
低風險, 不建議服用丹木斯acetazolamide
1. 無高海拔病病史，且上升海拔不超過2750m
2. 花兩天以上時間上升到2,500–3,000 m。
每天睡眠海拔上升小於500m，睡眠海拔每上升1000m就多休息1天
中度風險~應考慮預防性服用丹木斯,會有好處
1. 曾罹患高海拔病，且一天內上升至海拔2,500–2,800m
2. 沒有高海拔病病史，且一天之內上升海拔超過2,800 m
3.在海拔3000m以上，每天上升海拔超過500m，但每上升1000m有安排休息1天
高風險 ~強烈建議預防性服用丹木斯
1. 有高海拔病病史，且一天之內上升海拔超過2,800 m
2.曾罹患HAPE or HACE
3. 一天之內上升海拔超過3500m
4. 在海拔3000m以上，每天上升海拔超過500m，且每上升1000m沒有安排休息1天
5. 非常快速上升(像是登頂Kilimanjaro，只安排7天以下的天數)
Table 2-08. 各種不同病史的上升風險
可能無額外風險
小孩和青少年
老年人
缺乏運動的人
微胖
控制良好的氣喘患者
糖尿病
冠狀動脈疾病已打通血管
輕度COPD病人
低風險妊娠
輕度或中度阻塞性睡眠呼吸中止症
控制良好高血壓患者
控制良好的癲癇患者
精神病患者
有腫瘤患者
需注意
控制不佳的高血壓
控制不佳的癲癇
中度COPD患者
嚴重阻塞性睡眠呼吸中止症
穩定型心絞痛
冠狀動脈疾病血管未打通
帶鐮刀型貧血基因
肝硬化
輕度肺動脈高壓
作過放射性角膜手術
小於6個禮拜的嬰兒
代償性心臟衰竭
病態肥胖
囊狀纖維化 (FEV1 30%–50% predicted)
控制不佳的心律不整
控制不佳的氣喘
不建議上升
鐮刀型貧血
嚴重COPD
肺動脈高壓大於60mmHg
不穩定心絞痛
失償性心臟衰竭
高風險妊娠
囊狀纖維化 (FEV1 <30% predicted)
最近有中風的患者 (90 天內)
未治療腦部血管瘤或動靜脈異常
腦部佔位性病變
診斷與治療 DIAGNOSIS AND TREATMENT
AMS/ HACE高海拔腦水腫
AMS與HACE的鑑別診斷包括脫水、體力耗盡、低血糖、失溫、低血鈉。局部神經學症狀或抽搐在HACE是罕見的，應考慮顱內病灶或者癲癇。AMS患者可考慮下降300m，症狀會迅速減緩。若不下降而是每分鐘給予2L的氧氣，也可以很快減輕頭痛症狀，在數小時內改善AMS，但氧氣無法隨時取得。AMS 患者，可以待在原海拔治療，可服用一些非鴉片類止痛、止吐藥等藥物，如ondansetron。另外也可以服用丹木斯 acetazolamide，丹木斯可以加速高度適應，對於AMS也有良好的治療效果，但丹木斯預防性使用效果優於治療性使用。 類固醇比丹木斯能更快速減緩中度到重度的AMS。如果患者處於同一海拔休息服藥之後症狀更嚴重，則必須下降。
*(備註: Ondansetron 是一種效力強大、具有高度選擇性的5HT3 受體拮抗劑。它控制噁心及嘔吐的詳確作用機轉仍然不明。用於細胞毒性化學療法及放射線療法所致之噁心及嘔吐，以及手術引起之噁心、嘔吐。)
Acute Mountain Sickness/High-Altitude Cerebral Edema
The differential diagnosis of AMS/HACE includes dehydration, exhaustion, hypoglycemia, hypothermia, or hyponatremia. Focal neurologic symptoms, or seizures, are rare in HACE and should lead to suspicion of an intracranial lesion or seizure disorder. Patients with AMS can descend ≥300 m, and symptoms will rapidly abate. Alternatively, supplemental oxygen at 2 L per minute will relieve headache quickly and resolve AMS over hours, but it is rarely available. People with AMS can also safely remain at their current altitude and treat symptoms with nonopiate analgesics and antiemetics, such as ondansetron. They may also take acetazolamide, which speeds acclimatization and effectively treats AMS, but is better for prophylaxis than treatment. Dexamethasone is more effective than acetazolamide at rapidly relieving the symptoms of moderate to severe AMS. If symptoms are getting worse while the traveler is resting at the same altitude, or in spite of medication, he or she must descend.
高海拔腦水腫HACE是AMS持續惡化的結果，特徵是會有神經學異常，尤其是運動失調、神智混亂、神智改變。HACE可以伴隨著高海拔肺水腫HAPE一起發生。發生了HACE，如果在人多有可以提供醫療服務的地方，可在原海拔給予氧氣和類固醇治療。在偏遠地區如果懷疑罹患HACE，應開始降低海拔。如果無法下撤，給予氧氣或使用攜帶式加壓艙，加上類固醇治療也許可以保命。
HACE is an extension of AMS characterized by neurologic findings, particularly ataxia, confusion, or altered mental status. HACE may also occur in the presence of HAPE. People developing HACE in populated areas with access to medical care can be treated at altitude with supplemental oxygen and dexamethasone. In remote areas, descent should be initiated in any person suspected of having HACE. If descent is not feasible because of logistical issues, supplemental oxygen or a portable hyperbaric chamber in addition to dexamethasone can be lifesaving.
高海拔肺水腫 High-Altitude Pulmonary Edema HAPE
運動耐力減少、漸漸呼吸困難、休息時呼吸困難都可以是HAPE的症狀，鑑別診斷還包括肺炎、支氣管孿縮、心肌梗塞、肺栓塞。下降高度是一定要做的，但要盡量讓患者減少運動(例如減少患者背負重量, 攙扶患者, 甚至抬下山)。如果無法立即下降，提供氧氣或者是使用攜帶型加壓艙是非常重要的。輕度HAPE患者，如果可以取得氧氣(如高海拔醫院或診所)可以不用降低海拔，在原海拔用氧氣治療。但在資源有限、沒有犯錯空間的狀況下, 可輔助使用nifedipine 加上同時下降、給氧、或使用加壓艙。如果沒有nifedipine，可以使用威而鋼/犀利士,但不建議同時使用多種肺血管擴張劑。
Although the progression of decreased exercise tolerance, increased breathlessness, and breathlessness at rest is almost always recognizable as HAPE, the differential diagnosis includes pneumonia, bronchospasm, myocardial infarction, or pulmonary embolism. Descent in this situation is urgent and mandatory, and should be accomplished with as little exertion as is feasible for the patient. If descent is not immediately possible, supplemental oxygen or a portable hyperbaric chamber is critical. Patients with mild HAPE who have access to oxygen (at a hospital or high-altitude medical clinic, for example) may not need to descend to lower elevation and can be treated with oxygen at the current elevation. In the field setting, where resources are limited and there is a lower margin for error, nifedipine can be used as an adjunct to descent, oxygen, or portable hyperbaric therapy. A phosphodiesterase inhibitor may be used if nifedipine is not available, but concurrent use of multiple pulmonary vasodilators is not recommended.
藥物治療 Medications
In addition to the discussion below, recommendations for the usage and dosing of medications to prevent and treat altitude illness are outlined in Table 2-09.
對於高海拔病的預防與治療可以看table2-09
丹木斯 ACETAZOLAMIDE
丹木斯在上升前服用可以預防AMS, 在AMS症狀出現後服用，可以加速身體恢復。丹木斯工作原理是酸化血液，增加呼吸和血氧濃度，以加速高度適應。最低有效劑量每12小時服用125mg，可以減少副作用如手麻、想尿尿。在上升前一天開始服用，然後在同一海拔持續服用2天，如果2天後要繼續上升，可以持續服用。丹木斯過敏反應不常見。丹木斯屬於非抗生素類磺胺藥物，丹木斯並不會跟抗生素磺胺類有交互作用。但對於磺胺曾發生過敏性休克的人，最好不用服用。有嚴重盤尼西林過敏的人，有時對於丹木斯也會有過敏反應。兒童劑量是 5 mg/kg/day，最大劑量每天兩次每次125 mg
Acetazolamide prevents AMS when taken before ascent and can speed recovery if taken after symptoms have developed. The drug works by acidifying the blood, which causes an increase in respiration and arterial oxygenation and thus aids acclimatization. An effective dose that minimizes the common side effects of increased urination and paresthesias of the fingers and toes is 125 mg every 12 hours, beginning the day before ascent and continuing the first 2 days at altitude, or longer if ascent continues. Allergic reactions to acetazolamide are uncommon. As a nonantimicrobial sulfonamide, it does not cross-react with antimicrobial sulfonamides. However, it is best avoided by people with history of anaphylaxis to any sulfa. People with history of severe penicillin allergy have occasionally had allergic reactions to acetazolamide. The pediatric dose is 5 mg/kg/day in divided doses, up to 125 mg twice a day.
類固醇DEXAMETHASONE
類固醇可以有效預防與治療AMS和HACE，另外也可以預防HAPE。不像丹木斯，類固醇如果在適應之前停藥，會發生反彈效應(症狀再發)。上升時預防AMS通常選擇丹木斯，類固醇通常用於治療AMS，以及輔助用於下降。大人劑量每6小時4mg(治療劑量)。目前趨勢是在登頂日服用類固醇，例如攀登吉力馬札羅峰 Kilimanjaro和阿空加瓜峰 Aconcagua(南美洲最高峰)時，以預防突乎期來的高海拔病。
Dexamethasone is effective for preventing and treating AMS and HACE and prevents HAPE as well. Unlike acetazolamide, if the drug is discontinued at altitude before acclimatization, mild rebound can occur. Acetazolamide is preferable to prevent AMS while ascending, with dexamethasone reserved for treatment, as an adjunct to descent. The adult dose is 4 mg every 6 hours. An increasing trend is to use dexamethasone for “summit day” on high peaks such as Kilimanjaro and Aconcagua, in order to prevent abrupt altitude illness.
NIFEDIPINE 鈣離子阻斷劑, 降血壓藥物
Nifedipine可以預防高海拔肺水腫，也可以改善高海拔肺水腫症狀。曾發生過高海拔肺水腫病史才考慮預防性服用。成人預防和治療的劑量是每12小時30mg(長效釋放型)，或每8小時20m
g (預防及治療的劑量相同)
Nifedipine prevents HAPE and ameliorates it as well. For prevention, it is generally reserved for people who are particularly susceptible to the condition. The adult dose for prevention or treatment is 30 mg of extended release every 12 hours, or 20 mg every 8 hours.
其它藥物
威而鋼/犀利士可選擇性降低肺動脈壓，不太影響全身血壓。在上升時，每次服用 10mg 犀利士每天兩次, 可以預防高海拔肺水腫，犀利士目前也被研究用於治療HAPE(尚未有明確療效)。成人在上升前服用銀杏每天兩次，每次100-120mg，在某些研究顯示可減少AMS，但有些研究則顯示無效。銀杏對於其他高海拔病並無效用，或許與藥物成分差異有關，Ibuprofen每8小時服用600mg可預防AMS, 但效果比丹木斯差，好處是不需醫師處方，便宜，藥物耐受性佳
Phosphodiesterase-5 inhibitors can also selectively lower pulmonary artery pressure, with less effect on systemic blood pressure. Tadalafil, 10 mg twice a day, during ascent can prevent HAPE and is being studied for treatment. When taken before ascent, gingko biloba, 100–120 mg twice a day, was shown to reduce AMS in adults in some trials, but it was not effective in others, probably due to variation in ingredients. Ibuprofen 600 mg every 8 hours was recently found to help prevent AMS, although it was not as effective as acetazolamide. However, it is over-the-counter, inexpensive, and well-tolerated.
預防嚴重的高海拔病或者死亡 PREVENTION OF SEVERE ALTITUDE ILLNESS OR DEATH
指引旅遊者最重要的不是去減少輕微高海拔疾病的機率，而是去避免死亡或脫困。因為高海拔疾病的進程緩慢且可預測，所以沒有理由因為高海拔疾病而丟了性命，除非是因為受困於地形或天氣而不能下撤。
遵守三個準則，來預防高海拔病造成的死亡或嚴重後果。
1.瞭解高海拔病早期症狀, 願意承認自己得了高海拔疾病
2.不管症狀多麼輕微，不要帶著症狀繼續上升到更高的海拔過夜。
3.如果待在同一海拔休息，症狀惡化應開始下撤
The main point of instructing travelers about altitude illness is not to eliminate the possibility of mild illness but to prevent death or evacuation. Since the onset of symptoms and the clinical course are sufficiently slow and predictable, there is no reason for anyone to die from altitude illness, unless trapped by weather or geography in a situation in which descent is impossible. Three rules can prevent death or serious consequences from altitude illness:
· Know the early symptoms of altitude illness, and be willing to acknowledge when they are present.
· Never ascend to sleep at a higher altitude when experiencing symptoms of altitude illness, no matter how minor they seem.
· Descend if the symptoms become worse while resting at the same altitude.
徒步旅行的隊伍，進入到偏遠山區，無法下降至低海拔，建議帶個加壓艙(例如Gamow
bag)。腳踏幫浦可將壓力提升至2 lb/in2，模擬下降海拔1,500–1,800m的狀態。加壓艙和幫浦總重大約是6.5kg
For trekking groups and expeditions going into remote high-altitude areas, where descent to a lower altitude could be problematic, a pressurization bag (such as the Gamow bag) can be beneficial. A foot pump produces an increased pressure of 2 lb/in2, mimicking a descent of 5,000–6,000 ft (1,500–1,800 m) depending on the starting altitude. The total packed weight of bag and pump is about 14 lb (6.5 kg).
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