野外與登山醫學--- 高海拔疾病 HAPE HACE 盛行率 發生率 死亡率

HAPE 高海拔肺水腫
HACE 高海拔腦水腫

根據一篇醫院的研究. 高海拔疾病死亡患者以高海拔肺水腫居多(死亡率不一定是最高)
High-altitude illness: Menace in Himalayas of Nepal (Annals of Medicine and Surgery
Volume 81, September 2022, 104494)
A hospital-based study estimated the incidence of altitude illness-related death to be 7.7/100,000 which is a significant number [14]. High-altitude pulmonary edema accounts for most deaths from high-altitude illness.


要注意的是, 隨著絕對海拔與上升速率, 高海拔疾病的盛行率會有很大差異.
兒童在台灣玉山的AMS 發生率 incidence 59%
https://www.ncbi.nlm.nih.gov/pubmed/26782126


2013NEJM
AMS 通常在上升到海拔2500公尺以上, 6-12小時之後發生。海拔越高，嚴重度及盛行率越高。沒有做高度適應的人，海拔2500公尺發生率 10-25%, 但症狀通常輕微，在海拔4500-5500公尺發生率50-85%. 且可能病倒。


尼泊爾地區 4243至5500 公尺的健行者 HACE 發生率約 1%.
在海拔 4555 公尺的西藏, 5355名遊客中, HACE 發生率 0.5%.
已經罹患HAPE的患者. 發生HACE的機率更高.

2017年HAPE這篇的數據: HAPE嚴重度決定於多項因素, 包括海拔, 初步認知, 處置, 尋求醫療協助, 在海拔 4500 公尺的發生率 0.6%-6%, 在海拔 5500 公尺的發生率高達 60%. 個人體能無法避免HAPE發生. (level of fitness.) 經過治療的死亡率 11%, 未治療死亡率 50%, 大約 50% HAPE患者會同時罹患AMS,. 14% 同時罹患HACE.


西藏機場海拔 3600 公尺. AMS 57.2% ; HAPE 1.9%; HACE 0% 無

藥物這篇剛好有提到發生率. 海拔 4500 公尺的HAPE發生率 0.6%-6%,
海拔 5500 公尺的HAPE 發生率高達 60%.
HAPE 高海拔肺水腫發生率 0.01-15% (在同樣海拔上升速率, 比 HACE 高). 通常在到達高海拔之後 2-4 天發作.
HACE 高海拔腦水腫 發生率 1-2%. 通常會合併嚴重AMS 或 HAPE.


參考資料~
2016年台灣醫師發表在旅遊醫學雜誌的文章 Incidence and risk factors associated with acute mountain sickness in children trekking on Jade Mountain, Taiwan.
Chan CW1, Lin YC2, Chiu YH3, Weng YM1, Li WC4, Lin YJ5, Wang SH6, Hsu TY7, Huang KF8, Chiu TF9.
Author information
Abstract
BACKGROUND:
Acute mountain sickness (AMS) is a pathophysiological symptom complex that occurs in high-altitude areas. The incidence of AMS on Jade Mountain, the highest peak in Taiwan (3952 m), has been reported to be ∼36%. There is a lack of data in children trekking at altitude in Taiwan. The purpose of this study was to determine the incidence, risk factors and symptoms of AMS in children trekking on Jade Mountain, Taiwan.
METHODS:
This prospective cohort study included a total of 96 healthy non-acclimatized children aged 11-12 years who trekked from an elevation of 2600-3952 m in 3 days. The Lake Louise AMS score was used to record symptoms associated with AMS.
RESULTS:
AMS were reported in 59% of children trekking on Jade Mountain over a 3 day period. AMS incidence increased significantly with increasing altitude. The most common AMS symptom was headache, followed by fatigue or weakness, difficulty sleeping, dizziness or lightheadedness and gastrointestinal symptoms. Children who had experienced upper respiratory infection (URI) within the 7 days before their trek tended to have a greater risk for development of AMS. AMS incidence did not significantly differ according to gender, recent acute gastroenteritis, menstruation and body mass index.



CONCLUSIONS:
The incidence of AMS in children trekking on Jade Mountain is greater than that observed in adults, and was associated with altitude and recent URI.