Jacob D. Jensen; Andrew L. Vincent.
Last Update: December 17, 2019.
Introduction 簡介
高海拔腦水腫 HACE 是高海拔疾病的嚴重潛在致死表現, 特徵是運動失調, 疲憊, 神智改變
HACE 被視為是 AMS 末期表現, 雖然 HACE 在高海拔疾病的發生率不高, 但可能在 24 小時內致死
(並非一定能活 24 小時, 而是 24 小時內若沒有適當診斷治療可能死亡)
(HACE沒有黃金時間, 一但診斷需立即處置)
High Altitude Cerebral Edema (HACE) is a severe and potentially fatal manifestation of high altitude illness and is often characterized by ataxia, fatigue, and altered mental status. HACE is often thought of as an extreme form/end-stage of Acute Mountain Sickness (AMS). Although HACE represents the least common form of altitude illness, it may progress rapidly to coma and death as a result of brain herniation within 24 hours, if not promptly diagnosed and treated.
Etiology 病因
(HACE沒有黃金時間, 一但診斷需立即處置)
High Altitude Cerebral Edema (HACE) is a severe and potentially fatal manifestation of high altitude illness and is often characterized by ataxia, fatigue, and altered mental status. HACE is often thought of as an extreme form/end-stage of Acute Mountain Sickness (AMS). Although HACE represents the least common form of altitude illness, it may progress rapidly to coma and death as a result of brain herniation within 24 hours, if not promptly diagnosed and treated.
Etiology 病因
HACE通常在上升到海拔 4000m 以上兩天後發生, 但也可能在較低海拔 2500m 快速發生.
有一些患者會出現AMS症狀, 但並非全部. 也有些人會同時罹患 HAPE.
單獨發生HACE較罕見, 但即使沒有先出現 HAPE或 AMS, 也不能直接排除 HACE.
HACE generally occurs after 2 days above 4000m but can occur at lower elevations (2500m) and with faster onset. Some, but not all, individuals will suffer from symptoms of AMS such as headache, insomnia, anorexia, nausea prior to transitioning to HACE. Some may also have concomitant High Altitude Pulmonary Edema (HAPE). HACE in isolation is rare, but the absence of concomitant HAPE or symptoms of AMS prior to deterioration does not rule-out the presence of HACE.
HACE generally occurs after 2 days above 4000m but can occur at lower elevations (2500m) and with faster onset. Some, but not all, individuals will suffer from symptoms of AMS such as headache, insomnia, anorexia, nausea prior to transitioning to HACE. Some may also have concomitant High Altitude Pulmonary Edema (HAPE). HACE in isolation is rare, but the absence of concomitant HAPE or symptoms of AMS prior to deterioration does not rule-out the presence of HACE.
Epidemiology
HACE在海拔 4000-5000 公尺的盛行率約 0.5-1%, HACE 會影響各年齡層與性別, 但年輕患者的機率較高 (年輕人較高的原因, 例如帶著症狀上升, 或爬升速率較快)
HACE危險因子包括
1. prior history of high altitude illness 先前曾經罹患高海拔疾病
2. lack of acclimatization 缺乏高度適應
3. heavy physical exertion 大量體力活動
4. rapid rate of ascent 快速上升
5. abrupt ascent from lower altitudes. 突然從低海拔爬升至高海拔
Incidence of HACE is 0.5-1% at altitudes of 4000-5000 m. HACE affects those of all ages and genders, though younger males may be at higher risk due to continuation of ascent despite symptoms of AMS and faster rate of ascent. Risk factors include prior history of high altitude illness, lack of acclimatization, heavy physical exertion, rapid rate of ascent, and abrupt ascent from lower altitudes.
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