下面這張表格才是對的
下面這張排版有問題.
Q：高海拔疾病如何診斷?
A：根據露易絲湖高海拔疾病診斷準則（Lake Louise Consensus Criteria）:
看到上面排版.
請問. 高海拔肺水腫的診斷標準是根據Lake Louise Consensus 制定的嗎??
並不是
來看一下原版的 The 2018 Lake Louise Acute Mountain Sickness Score
這個評分表僅針對AMS. 並不包含 HAPE 或 HACE
再回到原點. 找一下 1992 年的這篇. 開頭雖然是說 altitude illness. 但是....
The Lake Louise consensus on the quantification of altitude illness
January 1992
點進去之後會發現. 文章標題還是在說 AMS. 裡面沒提到 HAPE. HACE.
(中文為google翻譯)
THE LAKE LOUISE ACUTE MOUNTAIN SICKNESS SCORING SYSTEM
摘要
Roach、Robert C.、Peter H. Hackett、Oswald Oelz、Peter Bärtsch、Andrew M. Luks、Martin J. MacInnis、J. Kenneth Baillie 和路易斯湖 AMS 分數共識委員會。 2018 年路易斯湖急性高山症評分。High Alt Med Biol 19:1–4, 2018。 —路易斯湖急性高山症(AMS) 評分系統自1991 年首次發布以來一直是一種有用的研究工具。疾病之一AMS 症狀評分更可能是由於高原缺氧本身造成的，與 AMS 關係並不密切。為了解決這個問題，也為了根據數十年的經驗評估路易斯湖AMS評分，高海拔研究專家對評分進行了修訂。我們在此提出一份國際共識聲明，該聲明是根據2014 年5 月在義大利博爾扎諾舉行的國際山地醫學學會世界大會和2015 年2 月在加拿大路易斯湖舉行的國際缺氧研討會上的線上討論和會議得出的。
Abstract
Roach, Robert C., Peter H. Hackett, Oswald Oelz, Peter Bärtsch, Andrew M. Luks, Martin J. MacInnis, J. Kenneth Baillie, and The Lake Louise AMS Score Consensus Committee. The 2018 Lake Louise Acute Mountain Sickness Score. High Alt Med Biol 19:1–4, 2018.— The Lake Louise Acute Mountain Sickness (AMS) scoring system has been a useful research tool since first published in 1991. Recent studies have shown that disturbed sleep at altitude, one of the five symptoms scored for AMS, is more likely due to altitude hypoxia per se, and is not closely related to AMS. To address this issue, and also to evaluate the Lake Louise AMS score in light of decades of experience, experts in high altitude research undertook to revise the score. We here present an international consensus statement resulting from online discussions and meetings at the International Society of Mountain Medicine World Congress in Bolzano, Italy, in May 2014 and at the International Hypoxia Symposium in Lake Louise, Canada, in February 2015. The consensus group has revised the score to eliminate disturbed sleep as a questionnaire item, and has updated instructions for use of the score.
介紹
Introduction
Acute mountain sickness (AMS) is the most common form of acute altitude illness and typically occurs in unacclimatized persons ascending to altitudes >2500 m, although it can develop at lower altitudes in highly susceptible individuals. Established risk factors include rate of ascent, altitude reached, and individual predisposition. With 25 years of use in hundreds of publications, the Lake Louise AMS score has provided a robust and practical tool for researchers to diagnose and to score the severity of AMS. Recent opinion (Milledge, 2014) and research (MacInnis et al., 2013; Hall et al., 2014) have suggested that updating the Lake Louise AMS score is in order. This article outlines the brief historical background, reviews diagnostic criteria, describes modifications to the score, and offers suggested experimental procedures that may improve the use of the score in future studies.
背景
在 1991 年國際缺氧研討會上，參與者執行了由 Peter Hackett 和 Oswald Oelz 主持的共識流程（Hackett 等人，1992 年；原始文章的補充轉載可在線獲取www.liebertpub.com/ham），以定義和量化各種高原病。隨後在 1993 年的會議上，所有代表都有機會參與該文件的準備工作。 AMS 的評分由五種症狀組成（頭痛、腸胃不適、疲勞/虛弱、頭暈/頭暈和睡眠障礙），按嚴重程度從 0 到 3 進行評分。 Roach 等人，1993 年；原始文章的補充轉載可在線獲取www.liebertpub.com/ham）。總分≥3，且有頭痛，則被認為診斷為 AMS。
Background
At the 1991 International Hypoxia Symposium, the participants executed a consensus process chaired by Peter Hackett and Oswald Oelz (Hackett et al., 1992; supplementary reprint of original article is available online at www.liebertpub.com/ham) to define and quantify the various altitude illnesses. Subsequently at the 1993 conference, all delegates were given the opportunity to have input into the preparation of the document. The score for AMS consisted of the five symptoms (headache, gastrointestinal upset, fatigue/weakness, dizziness/light-headedness, and sleep disturbance), rated on a scale of severity from 0 to 3. The double-worded terms were to facilitate understanding as well as translation into many languages (Roach et al., 1993; supplementary reprint of original article is available online at www.liebertpub.com/ham). A total score ≥3, in the presence of a headache, was considered diagnostic for AMS.
方法
這項工作是2014 年5 月在義大利博爾扎諾舉行的國際山地醫學學會世界大會和2015 年2 月在加拿大路易斯湖舉行的國際缺氧研討會上線上討論和會議的結果。是參加過線上或現場討論的人員並在框中按字母順序列出。
Methods
This effort is the result of online discussions and meetings at the International Society of Mountain Medicine World Congress in Bolzano, Italy, in May 2014 and at the International Hypoxia Symposium in Lake Louise, Canada, in February 2015. Members of the consensus committee are those who have participated in the online or in-person discussions and are listed in alphabetical order in the box.
修改路易斯湖 AMS 評分的理由
儘管評分系統的使用有助於標準化 AMS 的診斷和嚴重程度，但自該系統誕生以來，關於睡眠是否應納入診斷標準的爭論一直存在。最近，這種討論愈演愈烈。 2013 年的兩份獨立報告提供了經驗證據，顯示睡眠障礙與 AMS 的其他症狀不一致（MacInnis 等人，2013 年；Hall 等人，2014 年）。霍爾等人。 ( 2014 ) 對 292 名暴露於海拔 3650 至 5200 m 的研究志願者的數據進行網絡分析，證明睡眠障礙與 AMS 的其他症狀相關性較差。重要的是，40% 的嚴重頭痛病例沒有睡眠障礙，長期以來，這被認為是 AMS 的一個標誌。麥金尼斯等人。 ( 2013 ) 對海拔 4390 m 的 491 名尼泊爾朝聖者的 Lake Louise AMS 評分進行了因子分析，結果顯示睡眠與評分中的其他四種症狀只有微弱的關係。 Milledge 也根據他自己的 AMS 研究經驗，對睡眠障礙是否是 AMS 的症狀，或者更確切地說是缺氧本身的影響表示懷疑（ Milledge， 2014）。隨著時間的推移，人們認識到的另一個問題是，許多 AMS 研究僅使用白天的暴露量，使得睡眠成分變得無關緊要。這些研究中沒有睡眠評分，因此很難與過夜研究進行比較。基於這些擔憂，共識委員會建議從路易斯湖 AMS 評分中刪除睡眠部分。
Rationale for Revising the Lake Louise AMS Score
Although use of the scoring system has helped standardize the diagnosis and severity of AMS across research studies, debate has persisted since its inception regarding whether sleep should be included in the diagnostic criteria. Recently this discussion has intensified. Two independent reports in 2013 provided empirical evidence that sleep disturbance is discordant from other symptoms of AMS (MacInnis et al., 2013; Hall et al., 2014). Hall et al. (2014) used network analysis of data from 292 research volunteers exposed to altitudes from 3650 to 5200 m to demonstrate that sleep disturbance correlated poorly with other symptoms of AMS. Importantly, sleep disturbance was absent in 40% of cases with severe headache, long considered a hallmark of AMS. MacInnis et al. (2013) applied factor analysis to Lake Louise AMS scores of 491 Nepalese pilgrims at 4390 m and revealed that sleep had only a weak relationship with the other four symptoms in the score. Milledge also expressed doubt as to whether sleep disturbance was a symptom of AMS, or rather an effect of hypoxia per se, based on his own experience with AMS studies (Milledge, 2014). Another problem recognized over time is that many studies of AMS have used only daytime exposures, making the sleep component irrelevant. Without a score for sleep in these studies, comparison with overnight studies is difficult. Based on these concerns, the consensus committee recommends that the sleep component be removed from the Lake Louise AMS score.
AMS的診斷標準和評估
AMS 被定義為路易斯湖 AMS 評分總計為 3 分或以上，來自四種評級症狀，其中至少 1 分來自最近上升或海拔升高時的頭痛（Roach 等人，2011 年；West，2011 年））（表1）。一些作者建議診斷 AMS 的閾值較高（Maggiorini 等人，1998；Bärtsch 等人，2004），但共識委員會認為，透過消除睡眠問題，更多患有真正 AMS 的人將在閾值處被識別出來。點，包括頭痛。缺乏足夠的研究將分數分為嚴重程度排名。對於願意這樣做的人，我們建議輕度AMS為3-5分，中度AMS為6-9分，重度AMS為10-12分。儘管症狀可能在海拔升高後 6 小時內出現，但我們建議僅在 6 小時後評估 AMS 評分，以避免將 AMS 與旅行或急性缺氧反應（例如迷走神經反應）引起的混雜症狀混淆。如果研究人員希望評估 AMS 症狀對高海拔地區整體功能的影響，可以使用「AMS 臨床功能評分」（表 1）。
Diagnostic Criteria and Assessment of AMS
AMS is defined as a Lake Louise AMS score total of three or more points from the four rated symptoms, including at least one point from headache in the setting of a recent ascent or gain in altitude (Roach et al., 2011; West, 2011) (Table 1). Some authors have suggested a higher cutoff for diagnosing AMS (Maggiorini et al., 1998; Bärtsch et al., 2004), but the consensus committee believes that by eliminating the sleep question, more people with true AMS will be identified at the threshold of three points, including headache. Sufficient research is lacking to divide the score into severity rankings. For those who wish to do so, we suggest mild AMS as 3–5 points, moderate AMS as 6–9 points, and severe AMS as 10–12 points. Although symptoms can develop within 6 hours of gain in altitude, we recommend assessing AMS score only after 6 hours, to avoid confusing AMS with confounding symptoms from travel or responses to acute hypoxia (e.g., vagal responses). If investigators wish to assess the impact of AMS symptoms on overall function at high altitude, the “AMS Clinical Functional Score” is available (Table 1).
AMS 切勿與高原腦水腫 (HACE) 混淆。單獨的 AMS 沒有表現出神經學發現，並且具有自限性。相較之下，HACE 通常在海拔升高後24 至72 小時內發生，其特徵是精神狀態改變和/或共濟失調，通常發生在患有AMS 或高原肺水腫的人身上，是一種醫學上的疾病。
AMS must not be confused with high-altitude cerebral edema (HACE). AMS alone exhibits no neurological findings, and is self-limited. In contrast, HACE, which usually comes on between 24 and 72 hours after a gain in altitude, is characterized by change in mental status and/or ataxia, occurs usually in a person with AMS or high-altitude pulmonary edema, and is a medical emergency (Hackett and Roach, 2004; Willmann et al., 2014).
路易斯湖 AMS 分數使用說明
路易斯湖 AMS 評分供研究 AMS 的調查人員使用。它不適合臨床醫生、專業戶外嚮導和非專業人員用來診斷或管理 AMS。在最近海拔升高或引起缺氧，且暴露時間至少為 6 小時後，AMS 評分如下使用：
1. Lake Louise AMS 評分設計為一份自我報告問卷，由研究志願者自行完成。然而，一些調查人員更喜歡向志願者朗讀問題並記錄答案，而另一些調查人員則採用兩步法，其中志願者首先完成評分，然後調查人員口頭驗證答案。只要研究中的所有受試者使用統一的方法，並且在後續報告中明確描述收集資料的方法，這些選項都是可以接受的。
2. 個體的路易斯湖 AMS 評分是四種症狀（頭痛、噁心/嘔吐、疲勞和頭暈/頭暈）的評分總和。對於正面的 AMS 定義，頭痛評分必須至少為 1 分，總分至少為 3 分。
範例 1：出於研究目的，總分大於兩分但沒有頭痛被定義為 NO AMS，但出於臨床目的，沒有頭痛並不排除診斷。
範例 2：嚴重頭痛得分為 3 分，且沒有其他 AMS 症狀，則定義為 AMS。
3. 我們建議使用 AMS 臨床功能評分，並在適合研究設計時進行報告（Roach 等人，1993 年；原始文章的補充轉載可在線獲取www.liebertpub.com/ham；Meier等人，2017 年） ） 。
Directions for Using the Lake Louise AMS Score
This Lake Louise AMS score is for use by investigators studying AMS. It is not intended for use by clinicians, professional outdoor guides, and laypersons to diagnose or manage AMS. After a recent gain in altitude or induction of hypoxia, and an exposure of at least 6 hours duration, the AMS score is used as follows:
1. The Lake Louise AMS score is designed as a self-report questionnaire that research volunteers complete on their own. However, some investigators prefer to read the question to the volunteer and record the answers, whereas others use a two-step method wherein the volunteer first completes the score, then the investigator verbally verifies the answers. These options are acceptable as long as a uniform approach is used with all subjects in a study and the method of collecting data is clearly described in subsequent reports.
2. The Lake Louise AMS score for an individual is the sum of the score for the four symptoms (headache, nausea/vomiting, fatigue, and dizziness/light-headedness). For a positive AMS definition, it is mandatory to have a headache score of at least one point, and a total score of at least three points.
Example 1: A total score greater than two points but with no headache is defined as NO AMS for research purposes, although absence of a headache does not exclude a diagnosis for clinical purposes.
Example 2: A score of three points for a severe headache, with no other AMS symptoms, is defined as AMS.
3. We suggest using the AMS clinical functional score and reporting it when suitable to the study design (Roach et al., 1993; supplementary reprint of original article is available online at www.liebertpub.com/ham; Meier et al., 2017).
未來研究的途徑
進一步的研究應集中在以下幾個方面：（1）路易斯湖AMS評分管理的最佳方法；也就是說，研究者主導的評分是否與志願者完成的評分不同/更好？ （2）實驗設計、測試環境以及研究志願者（即反安慰劑）的期望（Benedetti et al., 2014）對Lake Louise AMS評分可靠性的影響； (3) AMS 評分嚴重程度對臨床和功能的影響； (4) 非專業臨床醫生、登山嚮導和非專業人士使用路易斯湖 AMS 評分和臨床功能評分的最佳實踐（Roach 等人，1993 年；原始文章的補充轉載可在線獲取www.liebertpub.com/ham邁爾等人，2017）； (5) 睡眠障礙對高海拔地區整體健康的影響，與 AMS 無關； (6) 典型 AMS 的病理生理學與無頭痛表現的比較（Roach 等，2011；West，2011）。此外，我們強烈鼓勵研究人員公佈所有志願者和所有症狀的所有個人得分。這將使其他研究人員能夠直接比較疾病模式、編制薈萃分析並檢查原始數據以獲取想法和觀察結果，從而進一步完善 AMS 的共識定義和評分。
Overall, if you had any symptoms, how did they affect your activity? o No reduction in activity 1 Mild reduction in activity 2 Moderate reduction in activity 3 Severe reduction in activity (e.g. bedrest)
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