美國疾管局2024年黃皮書-關於高海拔疾病-HAPE的段落
(註. HAPE 和 HACE 死亡率到底哪個高?)
診斷
早期診斷是關鍵； HAPE 比 HACE 更容易致命。最初的症狀包括胸悶、咳嗽、運動時呼吸困難、運動能力下降。如果未被識別和治療，HAPE 會發展為休息時呼吸困難和明顯的呼吸窘迫，通常伴隨血痰。這種持續 1-2 天的典型進展很容易被識別為 HAPE，但這種情況有時僅表現為中樞神經系統功能障礙，伴隨意識模糊和嗜睡。
高海拔肺水腫
HAPE可以單獨發生，也可以與AMS和HACE同時發生；在科羅拉多州，發生率約為每 10,000 名滑雪者中 1 例，在 >14,000 英尺（約 4,300 m）處，每 100 名登山者中≤1 例。(註. HAPE 和 HACE 死亡率到底哪個高?)
診斷
早期診斷是關鍵； HAPE 比 HACE 更容易致命。最初的症狀包括胸悶、咳嗽、運動時呼吸困難、運動能力下降。如果未被識別和治療，HAPE 會發展為休息時呼吸困難和明顯的呼吸窘迫，通常伴隨血痰。這種持續 1-2 天的典型進展很容易被識別為 HAPE，但這種情況有時僅表現為中樞神經系統功能障礙，伴隨意識模糊和嗜睡。
大多數受害者均可偵測到囉音。脈搏血氧儀可以幫助診斷； HAPE 患者的氧飽和度水準比相同海拔的健康人低至少 10 個百分點。 50%–70% 的氧飽和度值很常見。 HAPE 的鑑別診斷包括支氣管痙攣、心肌梗塞、肺炎和肺栓塞。
High-Altitude Pulmonary Edema
HAPE can occur by itself or in conjunction with AMS and HACE; incidence is roughly 1 per 10,000 skiers in Colorado, and ≤1 per 100 climbers at >14,000 ft (≈4,300 m).
Diagnosis
Early diagnosis is key; HAPE can be more rapidly fatal than HACE. Initial symptoms include chest congestion, cough, exaggerated dyspnea on exertion, and decreased exercise performance. If unrecognized and untreated, HAPE progresses to dyspnea at rest and frank respiratory distress, often with bloody sputum. This typical progression over 1–2 days is easily recognizable as HAPE, but the condition sometimes presents only as central nervous system dysfunction, with confusion and drowsiness.
Rales are detectable in most victims. Pulse oximetry can aid in making the diagnosis; oxygen saturation levels will be at least 10 points lower in HAPE patients than in healthy people at the same elevation. Oxygen saturation values of 50%–70% are common. The differential diagnosis for HAPE includes bronchospasm, myocardial infarction, pneumonia, and pulmonary embolism.
2023-10-25 16:50
2012年台灣CDC高山症簡介有一張表格. 年代雖然久遠, 排版雖然有瑕疵. 但還是值得參考
(最後更新日期 2012/10/1)
The Lake Louise AMS Score Consensus Committee是定義 AMS 診斷標準. 而非 HACE/HAPE診斷標準.
2023-10-15 09:39AM
High-altitude pulmonary edema from uptodate
僅節錄診斷標準和影像檢查
1. HAPE 主要是臨床診斷(不需要抽血或影像檢查就可以診斷)
2. 通常發生在抵達高海拔 2-4 天出現(也有文獻說五天)
3. 症狀: 初期是乾咳. 呼吸急促. 運動時出現呼吸困難. 兒童的症狀可能會比成人更快出現
一兩天後開始出現咳嗽帶痰, 休息狀態仍呈現呼吸困難.
身體檢查主要異常: 心跳加速. 呼吸急促, 發燒(體溫 38度C), 肺部溼囉音
特定海拔的氧氣濃度低於預期值. 給予氧氣治療和休息會迅速改善.
4. 影像檢查可以幫助確診(但非必要)(包括x光,超音波,斷層等等)
HAPE 影像檢查與肺炎不同之處, HAPE影像看起來很嚴重, 但病患可能症狀沒有預期的那麼嚴重, 吸氧氣之後會迅速改善.
相反的. 一般肺炎患者, 如果x光片看到嚴重異常, 往往代表是病患病情比較嚴重, 病患會病懨懨的. 經過氧氣及其他治療, 通常無法快速改善. 常常會需要插管使用呼吸器.
google中文翻譯
診斷
HAPE 通常根據病史和檢查結果進行臨床診斷。最初的症狀通常在到達高海拔後兩到四天開始出現，包括輕微的乾咳、用力時呼吸急促以及上坡困難。兒童的症狀可能發展得更快。一到兩天后，咳嗽通常會變得有痰。從勞力性呼吸困難到休息時呼吸困難的早期進展是一個主要特徵。主要檢查結果包括心跳過速、呼吸急促、低燒（高達 38°C）和肺部濕囉音。在給定海拔高度下的氧飽和度低於預期。補充氧氣和休息治療可以使病情迅速改善。影像學檢查的特徵性發現（如果有且有指示）有助於確診。
DIAGNOSIS
HAPE is typically diagnosed clinically on the basis of the history and examination findings. The initial symptoms typically begin two to four days after arrival at high altitude and include a subtle nonproductive cough, shortness of breath on exertion, and difficulty walking uphill. Symptoms can develop more precipitously in children. Over one to two days, the cough often becomes productive. Early progression from dyspnea with exertion to dyspnea at rest is a cardinal feature. Prominent examination findings include tachycardia, tachypnea, low-grade fever (up to 38°C), and pulmonary crackles. Oxygen saturation is lower than expected for a given altitude. Treatment with supplemental oxygen and rest can lead to rapid improvement. Characteristic findings on imaging studies, when available and indicated, help to confirm the diagnosis.
google 中文翻譯
影像學研究
X 光平片、電腦斷層掃描和超音波心動圖 — 與急性高山症和高原腦水腫 (HACE) 一樣，HAPE 的診斷是基於病史和身體檢查。然而，胸部X光檢查是有用的，可以顯示特徵性的斑塊狀肺泡浸潤，主要是在右半胸中部，隨著疾病的進展，這些浸潤變得更加融合和雙側（圖1 ）。然而，在某些情況下，浸潤可能會從左肺開始[ 16 ]。很少見，水腫完全是單側的，即使很嚴重，這表明肺動脈發育不全或阻塞[ 17 ]。
儘管 HAPE 的放射學表現可能與感染性浸潤相似，但我們經常發現放射照片上的廣泛浸潤與患者的臨床狀態之間存在顯著差異。HAPE 患者的病情通常並不像根據 X 光檢查結果所預期的那樣嚴重，並且透過氧氣治療穩步改善。相較之下，因肺炎而出現類似胸部X光的患者通常病情危重，通常需要氣管插管和使用呼吸器機械通氣。
胸部電腦斷層掃描 (CT) 雖然很少顯示，但顯示出斑狀小葉磨玻璃樣外觀和實性混濁，反映了不均勻的肺泡充盈（圖 2 ）。心臟超音波顯示肺動脈壓力增加，有時會出現右心功能障礙和矛盾的室間隔運動[ 1,2 ]。
IMAGING STUDIES from uptodate
Plain radiograph, computed tomography, and echocardiography — As with acute mountain sickness and high-altitude cerebral edema (HACE), the diagnosis of HAPE is based upon the history and physical examination. However, chest radiography is useful and reveals characteristic patchy alveolar infiltrates, predominantly in the right central hemithorax, which become more confluent and bilateral as the illness progresses (image 1). However, in some cases, the infiltrates may start in the left lung [16]. Rarely, the edema is entirely unilateral even when severe, which suggests a pulmonary artery agenesis or obstruction [17].
Although the radiographic appearance of HAPE may mimic that of infectious infiltrates, we often find a significant discrepancy between the extensive infiltrates on radiograph and the patient's clinical status. The patient with HAPE often does not appear as severely ill as one would expect based on the radiograph findings and steadily improves with oxygen therapy. In contrast, a patient with a comparable chest radiograph due to pneumonia typically appears critically ill and often requires tracheal intubation and mechanical ventilation.
Computed tomography (CT) of the chest, while rarely indicated, reveals a patchy lobular ground-glass appearance and consolidative opacities, reflecting heterogeneous alveolar filling (image 2). Echocardiography reveals increased pulmonary artery pressure and sometimes right heart dysfunction and paradoxical septal motion [1,2].
另一篇參考資料 High Altitude Pulmonary Edema
Jacob D. Jensen; Andrew L. Vincent. Last Update: July 17, 2023.
節錄其中一段. 評估
裡面提到了. HAPE臨床診斷包括至少兩種症狀或主訴. 理學檢查(PE 身體檢查)有兩項異常. 而x光檢查會有以下異常發現: 肺葉浸潤. 中膈腔及心臟大小通常正常.
超音波可以看到 B lines
心電圖可能呈現 RAD或缺血變化
在X光出現浸潤的患者. 給予補充氧氣治療能快速緩解症狀. 是HAPE的病理性特徵
(其他原因引起的肺水腫通常不會這麼戲劇性改善)
(臨床診斷是指不需要照x光的情況. 根據病患症狀與身體檢查發現作診斷)
(需抽血或做影像檢查或做其他檢驗才能診斷的. 稱為實驗室診斷. 例如急性心肌梗塞的診斷)
下面是google中文翻譯.
評估
HAPE 的臨床診斷將包括以下至少兩種症狀或主訴：胸悶或疼痛、咳嗽、休息時呼吸困難以及運動耐受性下降。它還會有以下兩項檢查結果：中樞性紫紺、囉音/喘息、心跳過速和呼吸急促。如果有的話，CXR 可能顯示斑狀肺泡浸潤，縱膈/心臟大小正常，超音波可能顯示與肺水腫一致的 B 光。心電圖可能顯示電軸右偏和/或缺血的跡象。對於 CXR 上有浸潤的患者，透過補充氧氣快速糾正臨床狀態和 SpO2 是 HAPE 的特徵。即使可用，實驗室的效用也有限，臨床醫生應始終考慮伴隨的 AMS 和/或 HACE。
Evaluation
HAPE's clinical diagnosis would include at least two of the following symptoms or complaints: chest tightness or pain, cough, dyspnea at rest, and decreased exercise tolerance. It also would have two of the following exam findings: central cyanosis, rales/wheezes, tachycardia, and tachypnea. If available, CXR may show patchy alveolar infiltrates with normal-sized mediastinum/heart, and ultrasound may show B-lines consistent with pulmonary edema. ECG may show signs of right axis deviation and/or ischemia. In a patient with infiltrates on CXR, rapid correction of clinical status and SpO2 with supplemental oxygen is pathognomonic of HAPE. Even if available, labs are of limited utility, and the clinician should always consider concomitant AMS and/or HACE.
(最後更新日期 2012/10/1)
The Lake Louise AMS Score Consensus Committee是定義 AMS 診斷標準. 而非 HACE/HAPE診斷標準.
2023-10-15 09:39AM
High-altitude pulmonary edema from uptodate
僅節錄診斷標準和影像檢查
1. HAPE 主要是臨床診斷(不需要抽血或影像檢查就可以診斷)
2. 通常發生在抵達高海拔 2-4 天出現(也有文獻說五天)
3. 症狀: 初期是乾咳. 呼吸急促. 運動時出現呼吸困難. 兒童的症狀可能會比成人更快出現
一兩天後開始出現咳嗽帶痰, 休息狀態仍呈現呼吸困難.
身體檢查主要異常: 心跳加速. 呼吸急促, 發燒(體溫 38度C), 肺部溼囉音
特定海拔的氧氣濃度低於預期值. 給予氧氣治療和休息會迅速改善.
4. 影像檢查可以幫助確診(但非必要)(包括x光,超音波,斷層等等)
HAPE 影像檢查與肺炎不同之處, HAPE影像看起來很嚴重, 但病患可能症狀沒有預期的那麼嚴重, 吸氧氣之後會迅速改善.
相反的. 一般肺炎患者, 如果x光片看到嚴重異常, 往往代表是病患病情比較嚴重, 病患會病懨懨的. 經過氧氣及其他治療, 通常無法快速改善. 常常會需要插管使用呼吸器.
google中文翻譯
診斷
HAPE 通常根據病史和檢查結果進行臨床診斷。最初的症狀通常在到達高海拔後兩到四天開始出現，包括輕微的乾咳、用力時呼吸急促以及上坡困難。兒童的症狀可能發展得更快。一到兩天后，咳嗽通常會變得有痰。從勞力性呼吸困難到休息時呼吸困難的早期進展是一個主要特徵。主要檢查結果包括心跳過速、呼吸急促、低燒（高達 38°C）和肺部濕囉音。在給定海拔高度下的氧飽和度低於預期。補充氧氣和休息治療可以使病情迅速改善。影像學檢查的特徵性發現（如果有且有指示）有助於確診。
DIAGNOSIS
HAPE is typically diagnosed clinically on the basis of the history and examination findings. The initial symptoms typically begin two to four days after arrival at high altitude and include a subtle nonproductive cough, shortness of breath on exertion, and difficulty walking uphill. Symptoms can develop more precipitously in children. Over one to two days, the cough often becomes productive. Early progression from dyspnea with exertion to dyspnea at rest is a cardinal feature. Prominent examination findings include tachycardia, tachypnea, low-grade fever (up to 38°C), and pulmonary crackles. Oxygen saturation is lower than expected for a given altitude. Treatment with supplemental oxygen and rest can lead to rapid improvement. Characteristic findings on imaging studies, when available and indicated, help to confirm the diagnosis.
google 中文翻譯
影像學研究
X 光平片、電腦斷層掃描和超音波心動圖 — 與急性高山症和高原腦水腫 (HACE) 一樣，HAPE 的診斷是基於病史和身體檢查。然而，胸部X光檢查是有用的，可以顯示特徵性的斑塊狀肺泡浸潤，主要是在右半胸中部，隨著疾病的進展，這些浸潤變得更加融合和雙側（圖1 ）。然而，在某些情況下，浸潤可能會從左肺開始[ 16 ]。很少見，水腫完全是單側的，即使很嚴重，這表明肺動脈發育不全或阻塞[ 17 ]。
儘管 HAPE 的放射學表現可能與感染性浸潤相似，但我們經常發現放射照片上的廣泛浸潤與患者的臨床狀態之間存在顯著差異。HAPE 患者的病情通常並不像根據 X 光檢查結果所預期的那樣嚴重，並且透過氧氣治療穩步改善。相較之下，因肺炎而出現類似胸部X光的患者通常病情危重，通常需要氣管插管和使用呼吸器機械通氣。
胸部電腦斷層掃描 (CT) 雖然很少顯示，但顯示出斑狀小葉磨玻璃樣外觀和實性混濁，反映了不均勻的肺泡充盈（圖 2 ）。心臟超音波顯示肺動脈壓力增加，有時會出現右心功能障礙和矛盾的室間隔運動[ 1,2 ]。
IMAGING STUDIES from uptodate
Plain radiograph, computed tomography, and echocardiography — As with acute mountain sickness and high-altitude cerebral edema (HACE), the diagnosis of HAPE is based upon the history and physical examination. However, chest radiography is useful and reveals characteristic patchy alveolar infiltrates, predominantly in the right central hemithorax, which become more confluent and bilateral as the illness progresses (image 1). However, in some cases, the infiltrates may start in the left lung [16]. Rarely, the edema is entirely unilateral even when severe, which suggests a pulmonary artery agenesis or obstruction [17].
Although the radiographic appearance of HAPE may mimic that of infectious infiltrates, we often find a significant discrepancy between the extensive infiltrates on radiograph and the patient's clinical status. The patient with HAPE often does not appear as severely ill as one would expect based on the radiograph findings and steadily improves with oxygen therapy. In contrast, a patient with a comparable chest radiograph due to pneumonia typically appears critically ill and often requires tracheal intubation and mechanical ventilation.
Computed tomography (CT) of the chest, while rarely indicated, reveals a patchy lobular ground-glass appearance and consolidative opacities, reflecting heterogeneous alveolar filling (image 2). Echocardiography reveals increased pulmonary artery pressure and sometimes right heart dysfunction and paradoxical septal motion [1,2].
另一篇參考資料 High Altitude Pulmonary Edema
Jacob D. Jensen; Andrew L. Vincent. Last Update: July 17, 2023.
節錄其中一段. 評估
裡面提到了. HAPE臨床診斷包括至少兩種症狀或主訴. 理學檢查(PE 身體檢查)有兩項異常. 而x光檢查會有以下異常發現: 肺葉浸潤. 中膈腔及心臟大小通常正常.
超音波可以看到 B lines
心電圖可能呈現 RAD或缺血變化
在X光出現浸潤的患者. 給予補充氧氣治療能快速緩解症狀. 是HAPE的病理性特徵
(其他原因引起的肺水腫通常不會這麼戲劇性改善)
(臨床診斷是指不需要照x光的情況. 根據病患症狀與身體檢查發現作診斷)
(需抽血或做影像檢查或做其他檢驗才能診斷的. 稱為實驗室診斷. 例如急性心肌梗塞的診斷)
下面是google中文翻譯.
評估
HAPE 的臨床診斷將包括以下至少兩種症狀或主訴：胸悶或疼痛、咳嗽、休息時呼吸困難以及運動耐受性下降。它還會有以下兩項檢查結果：中樞性紫紺、囉音/喘息、心跳過速和呼吸急促。如果有的話，CXR 可能顯示斑狀肺泡浸潤，縱膈/心臟大小正常，超音波可能顯示與肺水腫一致的 B 光。心電圖可能顯示電軸右偏和/或缺血的跡象。對於 CXR 上有浸潤的患者，透過補充氧氣快速糾正臨床狀態和 SpO2 是 HAPE 的特徵。即使可用，實驗室的效用也有限，臨床醫生應始終考慮伴隨的 AMS 和/或 HACE。
Evaluation
HAPE's clinical diagnosis would include at least two of the following symptoms or complaints: chest tightness or pain, cough, dyspnea at rest, and decreased exercise tolerance. It also would have two of the following exam findings: central cyanosis, rales/wheezes, tachycardia, and tachypnea. If available, CXR may show patchy alveolar infiltrates with normal-sized mediastinum/heart, and ultrasound may show B-lines consistent with pulmonary edema. ECG may show signs of right axis deviation and/or ischemia. In a patient with infiltrates on CXR, rapid correction of clinical status and SpO2 with supplemental oxygen is pathognomonic of HAPE. Even if available, labs are of limited utility, and the clinician should always consider concomitant AMS and/or HACE.
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