統一名詞翻譯
AMS 急性高山病
HACE 高海拔腦水腫
acute altitude illness 急性高海拔疾病
SUGGESTED APPROACH TO AMS/HACE TREATMENT 治療AMS/HACE的方法
做出高山病的診斷時, 要排除其他會造成相似症狀的疾病, 例如一氧化碳中毒, 脫水, 體力不支, 低血糖, 失溫, 低血鈉
罹患AMS的病患, 不管HACE輕重度如何, 都應該停止上升. 依照疾病嚴重度級所處環境, 考慮撤退,
單純罹患AMS的人, 可以在原地休息, 給予非鴉片類止痛藥(治療頭痛,嘔吐), 但要有人在一旁監護
Care should be taken to exclude disorders whose symptoms and signs resemble those seen with AMS and HACE, such as carbon monoxide poisoning, dehydration, exhaustion, hypoglycemia, hypothermia, and hyponatremia. Persons with AMS of any severity or HACE should cease ascending and may need to consider descent, depending on the severity of illness and the circumstances (Table 3). Patients
with AMS can remain at their current altitude and use nonopioid analgesics for headache and antiemetics for nausea
and vomiting. These individuals should be closely observed
for signs of progression of altitude illness.
何時該下降?
1. AMS 症狀更惡化
2. 經適當治療之後 1-2 天仍有高海拔症狀
3. 丹木斯可加速高度適應, 對於輕微的AMS有些療效, 但將丹木斯做為預防性藥物可能更好
4. 類固醇
Descent should be initiated for AMS if symptoms worsen or fail to improve after 1 to 2 d of appropriate interventions.
Although acetazolamide facilitates acclimatization and is somewhat effective for treating mild illness, it is likely better for prevention than for treatment.
對於中度和重度AMS, 類固醇能提供較可靠的療效, 這些患者通常也應該下降
Dexamethasone is considered to be a more reliable treatment for moderate to severe AMS, which often also requires descent.
當AMS症狀改善後, 可再次上升, 症狀尚未完全改善前, 不可以再次爬升至先前罹患AMS的海拔,
Individuals with AMS may resume ascending once symptoms resolve. Further ascent or reascent to a previously attained altitude should never be undertaken if there are ongoing symptoms.
當AMS症狀改善後, 按照之前劑量繼續使用丹木斯,
After resolution of AMS, taking acetazolamide at preventive doses during reascent is prudent.
HACE與嚴重AMS區別在於是否有中樞神經系統症狀 , 包括在急速上升後出現運動失調, 神智混亂, 神智改變, HACE可發生在AMS之後, 也可能與 HAPE 同時發生,
HACE is differentiated from severe AMS by neurological signs such as ataxia, confusion, or altered mental status in the setting of acute ascent to high altitude and may follow AMS or occur concurrently with HAPE.
罹患 HACE 的人到達醫院/診所之後, 應該給予類固醇及氧氣治療, 將血氧飽和度提升超過 90%,
Individuals developing HACE in locations with access to hospitals or specialized clinics should be started on dexamethasone and supplemental oxygen sufficient to achieve an SpO2 >90%.
在遠離醫療資源的偏遠地區, 如果懷疑已經罹患 HACE, 或AMS症狀惡化, 給予類固醇和丹木斯無法改善症狀時, 應開始下降
In remote areas away from medical resources, descent should be initiated in any suspected cases of HACE or if symptoms of AMS are worsening despite treatment with acetazolamide or dexamethasone.
若無法下撤, 應該使用氧氣或攜帶式高壓艙, 罹患HACE的人應該同時給予類固醇, 至於在 HACE 改善後是否能繼續未完成的旅遊行程或探險, 目前無系統性資料或個案報告. 謹慎起見, 應避免使用類似的方法再次上升, 若還是想繼續上升, 上升前最低條件, 病患需完全沒有症狀, 至少兩三天沒有服用類固醇,
If descent is not feasible, supplemental oxygen or a portable hyperbaric chamber should be used. Persons with HACE should also be started on dexamethasone. There are no systematic data or case reports about reascent during the same trip or expedition after resolution of HACE. The prudent course is to avoid reascent in this situation, but if it is to be attempted, at a minimum the individual should be asymptomatic and no longer taking dexamethasone for at least 2 to 3 d before reascent.
何時該下降?
1. AMS 症狀更惡化
2. 經適當治療之後 1-2 天仍有高海拔症狀
3. 丹木斯可加速高度適應, 對於輕微的AMS有些療效, 但將丹木斯做為預防性藥物可能更好
4. 類固醇
Descent should be initiated for AMS if symptoms worsen or fail to improve after 1 to 2 d of appropriate interventions.
Although acetazolamide facilitates acclimatization and is somewhat effective for treating mild illness, it is likely better for prevention than for treatment.
對於中度和重度AMS, 類固醇能提供較可靠的療效, 這些患者通常也應該下降
Dexamethasone is considered to be a more reliable treatment for moderate to severe AMS, which often also requires descent.
當AMS症狀改善後, 可再次上升, 症狀尚未完全改善前, 不可以再次爬升至先前罹患AMS的海拔,
Individuals with AMS may resume ascending once symptoms resolve. Further ascent or reascent to a previously attained altitude should never be undertaken if there are ongoing symptoms.
當AMS症狀改善後, 按照之前劑量繼續使用丹木斯,
After resolution of AMS, taking acetazolamide at preventive doses during reascent is prudent.
HACE與嚴重AMS區別在於是否有中樞神經系統症狀 , 包括在急速上升後出現運動失調, 神智混亂, 神智改變, HACE可發生在AMS之後, 也可能與 HAPE 同時發生,
HACE is differentiated from severe AMS by neurological signs such as ataxia, confusion, or altered mental status in the setting of acute ascent to high altitude and may follow AMS or occur concurrently with HAPE.
罹患 HACE 的人到達醫院/診所之後, 應該給予類固醇及氧氣治療, 將血氧飽和度提升超過 90%,
Individuals developing HACE in locations with access to hospitals or specialized clinics should be started on dexamethasone and supplemental oxygen sufficient to achieve an SpO2 >90%.
在遠離醫療資源的偏遠地區, 如果懷疑已經罹患 HACE, 或AMS症狀惡化, 給予類固醇和丹木斯無法改善症狀時, 應開始下降
In remote areas away from medical resources, descent should be initiated in any suspected cases of HACE or if symptoms of AMS are worsening despite treatment with acetazolamide or dexamethasone.
若無法下撤, 應該使用氧氣或攜帶式高壓艙, 罹患HACE的人應該同時給予類固醇, 至於在 HACE 改善後是否能繼續未完成的旅遊行程或探險, 目前無系統性資料或個案報告. 謹慎起見, 應避免使用類似的方法再次上升, 若還是想繼續上升, 上升前最低條件, 病患需完全沒有症狀, 至少兩三天沒有服用類固醇,
If descent is not feasible, supplemental oxygen or a portable hyperbaric chamber should be used. Persons with HACE should also be started on dexamethasone. There are no systematic data or case reports about reascent during the same trip or expedition after resolution of HACE. The prudent course is to avoid reascent in this situation, but if it is to be attempted, at a minimum the individual should be asymptomatic and no longer taking dexamethasone for at least 2 to 3 d before reascent.
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