統一名詞翻譯
AMS 急性高山病
HACE 高海拔腦水腫
HAPE 高海拔肺水腫
acute altitude illness 急性高海拔疾病
高海拔肺水腫治療建議
SUGGESTED APPROACH TO HAPE TREATMENT
開始治療之前, 要考慮其他在高海拔會造成呼吸症狀的情況, 例如 氣喘, 氣管痙孿, 痰卡住, 肺炎, 氣胸, 肺栓塞, 感冒, 心肌梗塞.
Before initiating treatment, consideration should be given to other causes of respiratory symptoms at high altitude, such as asthma, bronchospasm, mucous plugging, pneumonia, pneumothorax, pulmonary embolism, viral upper respiratory tract infection, or myocardial infarction.
如果懷疑罹患 HAPE. 若有氧氣應開始給氧治療, 並降低海拔高度, 若無法立即下降高度 或 需要延緩下降, 應考慮持續給氧, 或使用加壓艙, 若患者能接受氧氣治療, 且在醫療環境受到適當的監視, 例如加護病房或急診室, 可以不用下降至低海拔, 在相同的海拔使用氧氣治療.
If HAPE is suspected or diagnosed, oxygen should be started if available, and descent to lower elevation should be initiated. If descent is infeasible or delayed, supplemental oxygen should be continued or the individual should be placed in a portable hyperbaric chamber. Patients who have access to supplemental oxygen and can be adequately monitored in a medical setting (eg, urgent care clinic or emergency department) may not need to descend to lower elevation and can be treated with oxygen alone at the current elevation.
如果給氧或使用持續性陽壓呼吸器之後, 氧氣飽和度沒有改善. 或氧氣飽和度改善(>90%)但仍病況惡化, 或經過適當處置之後, 病況沒有改善, 應立即下降.
Descent should be initiated, however, if oxygenation fails to improve with supplemental oxygen and/or CPAP, if the patient’s condition deteriorates despite achieving an oxygen saturation >90%, or if the patient fails to show signs of improvement with appropriate interventions for HAPE.
In more remote settings, early descent should be considered. Addition of nifedipine may not yield additional benefit in well-monitored settings.93,96 In the field setting, where resources are limited, nifedipine can be used as an adjunct to descent, supplemental oxygen, or portable hyperbaric therapy. It should only be used as primary therapy if none of these other measures is available. A phosphodiesterase inhibitor may be used if nifedipine is not available, but concurrent use of multiple pulmonary vasodilators is not recommended. In the hospital setting, CPAP can be considered as an adjunct to supplemental oxygen and nifedipine can be added if the patient fails to respond to oxygen therapy alone. There is no established role for beta-agonists, diuretics, acetazolamide, or dexamethasone in the treatment of HAPE, although, as noted below, dexamethasone should be considered when concern is raised for concurrent HACE. Selected patients (able to achieve an oxygen saturation >90%, with adequate support from family or friends, with adequate housing or lodging arrangements) may be discharged from direct medical care if they can continue using supplemental oxygen rather than being admitted to a healthcare facility. Individuals treated in this manner should be admitted to the hospital if they develop worsening symptoms and/or oxygen saturation while on supplemental oxygen. Descent to lower elevation should be pursued if oxygenation or other aspects of their condition worsen despite appropriate interventions for HAPE, as this suggests they may have alternative pathology that requires further evaluation and management. Individuals who develop HAPE may consider further ascent to higher altitude or reascent only when symptoms of HAPE have completely resolved and they maintain stable oxygenation at rest and with mild exercise while off supplemental oxygen and/or vasodilator therapy. Consideration may be given to using nifedipine or another pulmonary vasodilator upon resuming ascent
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