野外與登山醫學---39--WMS 2019 update HAPE + HACE TREATMENT APPROACH 39

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2019 Update

中文翻譯目錄

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

同時罹患高海拔肺水腫 HACE 與高海拔腦水腫 HAPE 的建議處置
SUGGESTED APPROACH FOR PATIENTS WITH CONCURRENT HAPE AND HACE

應使用類固醇, 劑量與 HACE 治療相同
有些罹患 HAPE 的病患可能會因為缺氧性腦病患而出現神經功能異常, 而非由 HACE 引起, 但在野外環境無法將缺氧的腦病變與 HACE 區隔, 因此 HAPE 患者若出現神經功能異常, 給予氧氣治療後, 如果血氧飽和度改善, 但症狀沒有迅速改善, 應使用類固醇
如果無法提供氧氣, 對於HAPE患者若出現神智改變,或懷疑有高海拔腦水腫, 應給予類固醇
同時罹患 HAPE 與 HACE 的患者可以服用鈣離子阻斷劑 Nifedipine 或其他肺血管擴張劑, 但要小心不要讓平均動脈壓降太低, 平均動脈壓降低可能減少腦部血流灌注. 增加腦缺血風險.


Dexamethasone should be added to the treatment regimen of patients with concurrent HAPE and HACE at the doses described earlier for patients with HACE. Some patients with HAPE may have neurologic dysfunction caused by hypoxic encephalopathy rather than caused by HACE, but making the distinction between hypoxic encephalopathy and HACE in the field can be difficult. Therefore, dexamethasone should be added to the treatment regimen for patients with HAPE with neurologic dysfunction that does not resolve rapidly with administration of supplemental oxygen and improvement in oxygen saturation. If supplemental oxygen is not available, dexamethasone should be started in addition to the medications for HAPE in patients with altered mental status and/or suspected concurrent HACE. Nifedipine or other pulmonary vasodilators may be used in patients with concurrent HAPE and HACE, with care to avoid lowering mean arterial pressure, as this may decrease cerebral perfusion pressure and thus increase the risk for cerebral ischemia.