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
簡介及高海拔定義
Introduction 簡介
到海拔 2500 公尺以上地區旅遊, 可能會罹患一種或多種高海拔疾病, 急性高山病AMS, 高海拔肺水腫 HAPE, 高海拔腦水腫 HAPE. 在高海拔地區或探險隊工作的醫師, 可能會遇到一些高海拔疾病的個案, 因此需要熟悉預防性處方以及治療方案.
WMS 召開專家會議, 發展實證醫學為基礎的指引, 以預防或治療高海拔疾病, 提出每一種疾病的預防或治療方式. 根據現有的證據以及利弊考量, 將各種建議分級, 這些建議適用於所有到高海拔活動的旅客, 不管是工作, 休閒, 健行, 滑雪, 或登山.
Travel to elevations above 2500 m is associated with risk of developing 1 or more forms of acute altitude illness: acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE). Because large numbers of people travel to such elevations, many clinicians are faced with questions from patients about the best means to prevent these disorders. In addition, clinicians working at facilities in high altitude regions or as members of expeditions traveling to such areas can expect to see persons who are experiencing these illnesses and must be familiar with prophylactic regimens and proper treatment protocols. To provide guidance to clinicians and disseminate knowledge about best practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for prevention and treatment of acute altitude illness. Preventive and therapeutic modalities are presented and recommendations made for each form of acute altitude illness. Recommendations are graded based on the quality of supporting evidence and consideration of benefits and risks/burdens associated with each modality. These recommendations are intended to apply to all travelers to high altitude, whether they are traveling to high altitude for work, recreation, or various activities including hiking, skiing, trekking, and mountaineering.
Defining the threshold for “high altitude” and when to apply these guidelines
高海拔定義, 何時可使用此指引
無法適應高海拔的人, 到達海拔 2500 公尺以上, 有罹患高海拔疾病的風險, 但以前的研究及臨床經驗顯示, 體質敏感的人, 在海拔 2000 公尺以上就有可能罹患 AMS, 甚至HAPE. HACE雖然多數都是在更高的海拔發生, 但也曾有案例在海拔 2500公尺發生 HACE 合併 HAPE.
我們很難界定到底多高的海拔可能發生高海拔疾病, 因為高海拔疾病中, 最常見的 AMS 的症狀並不具特異性, 甚至在幾個研究中, 研究對象在不提升海拔的狀況也符合AMS診斷, 因此在一些分析AMS發生率的研究中, 少許的海拔提升, 就會有一些研究對象被歸類到AMS患者, 而引起其症狀的原因可能不是高海拔, 這種情況會造成AMS發生率被高估,
Defining the threshold for “high altitude” and when to apply these guidelines
高海拔定義, 何時可使用此指引
無法適應高海拔的人, 到達海拔 2500 公尺以上, 有罹患高海拔疾病的風險, 但以前的研究及臨床經驗顯示, 體質敏感的人, 在海拔 2000 公尺以上就有可能罹患 AMS, 甚至HAPE. HACE雖然多數都是在更高的海拔發生, 但也曾有案例在海拔 2500公尺發生 HACE 合併 HAPE.
我們很難界定到底多高的海拔可能發生高海拔疾病, 因為高海拔疾病中, 最常見的 AMS 的症狀並不具特異性, 甚至在幾個研究中, 研究對象在不提升海拔的狀況也符合AMS診斷, 因此在一些分析AMS發生率的研究中, 少許的海拔提升, 就會有一些研究對象被歸類到AMS患者, 而引起其症狀的原因可能不是高海拔, 這種情況會造成AMS發生率被高估,
Unacclimatized individuals are at risk of high altitude illness when ascending to altitudes above 2500 m. Prior studies and extensive clinical experience, however, suggest that susceptible individuals can develop AMS, and potentially HAPE, at elevations as low as 2000 m. HACE is typically encountered at higher elevations but has also been reported at around 2500 m in patients with concurrent HAPE.7 Part of the difficulty in defining a specific threshold at which altitude illness can develop is the fact that the symptoms and signs of AMS, the most common form of altitude illness, are nonspecific, as demonstrated in several studies in which participants met criteria for the diagnosis of AMS despite no gain in altitude. As a result, studies assessing AMS incidence at modest 不大的 elevations may label individuals as having altitude illness when, in fact, symptoms are related to some other process, thereby falsely elevating the reported incidence of AMS at that elevation.
因為無法界定一個明確的海拔高度, 專家會議建議預防或治療高海拔疾病時, 不要完全依據海拔高度, 考慮預防策略時, 要根據每個人在以往高海拔地區旅遊的表現. 海拔爬升速率, 高度適應的時間天數
Recognizing the difficulty in defining a clear threshold, the expert panel recommends an approach to preventing and treating acute altitude illness that does not depend strictly on the altitude to which an individual is traveling. Preventive measures should be considered based on the altitude to which the individual is traveling and also account for factors such as history of performance at high altitude, rate of ascent, and availability of acclimatization days (described in greater detail later).
不要以海拔 2500 公尺以下, 來排除 AMS, HAPE, HACE 診斷. 還需要考慮是否有相符的臨床症狀, 謹慎的排除其他成因, 例如嚴重脫水, 低血鈉, 肺炎, 一氧化碳中毒, 低血糖等等.
Diagnoses of AMS, HAPE, or HACE should not be excluded based on the fact that an ill individual is below 2500 m. These diagnoses should be strongly considered in the presence of compatible clinical features, with careful attempts to exclude other entities such as severe dehydration, hyponatremia, pneumonia, carbon monoxide poisoning, and hypoglycemia.
Acute altitude illness WMS 2019 update AMS/HACE prevention Gradual ascent 1
漸進爬升, 每天爬升的海拔不要太快(通常指睡眠海拔), 對於預防高海拔疾病非常有效. 但以往對於這方面的研究, 通常是回溯性研究(缺點是無法要求實驗組與對照組的身體特質一致性), 只有兩篇是前瞻性研究 (先訂出收案條件以及想評估的項目, 再挑選合適的個案), 睡眠海拔比行進間曾爬升的最高海拔影響更大, 舉例, 第一天從海拔 2500公尺出發, 中間曾經爬升到海拔 3200 公尺, 之後下降到海拔 2900 公尺的營地睡覺, 爬升的海拔要用 2900-2500 公尺來計算, 一天爬升的海拔是 400 公尺,
漸進爬升是指每天睡眠海拔不要增加太多, 建議以此預防急性高山病 AMS 及 高海拔腦水腫 HACE.
Gradual ascent
Controlling the rate of ascent, in terms of the number of meters gained per day, is a highly effective means of preventing acute altitude illness; however, aside from 2 recent prospective studies,15,16 this strategy has largely been evaluated retrospectively.17 In planning the rate of ascent, the altitude at which someone sleeps is considered more important than the altitude reached during waking hours.
Controlling the rate of ascent, in terms of the number of meters gained per day, is a highly effective means of preventing acute altitude illness; however, aside from 2 recent prospective studies,15,16 this strategy has largely been evaluated retrospectively.17 In planning the rate of ascent, the altitude at which someone sleeps is considered more important than the altitude reached during waking hours.
Recommendation. Gradual ascent, defined as a slow increase in sleeping elevation, is recommended for AMS and HACE prevention. A specific approach is described further later in the text. Recommendation Grade: 1
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