下面中文使用GOOGLE翻譯
高海拔肺水腫 (HAPE) 的診斷需要非常具體的臨床背景——
未適應低海拔地區者攀登至海拔≥2500米——
並依賴於一組特徵性症狀，包括與既往高海拔經歷或其他人在相同海拔高度經歷的不相稱的運動性呼吸困難。
患者也可能出現乾咳、疲勞、疲倦和胸部咕嚕聲。隨著病情進展，患者在輕度運動或靜止狀態下會出現呼吸困難，並可能出現紫紺和咳出粉紅色泡沫痰。
個體就診的環境會影響診斷方法。在診斷資源有限的野外環境中，診斷可能僅基於病史。如果條件允許，脈搏血氧飽和度測定可以確認是否存在與特定海拔高度預期值不成比例的低氧血症，123 這是區分高海拔肺水腫 (HAPE) 與其他呼吸困難原因（例如焦慮或身體狀況不佳）的關鍵特徵，但必須注意避免在高海拔地區進行此類測量時可能出現的一些隱患。 124 便攜式超音波設備識別 B 線是一種敏感但不具特異性的診斷工具，125,126 但目前尚無公認的 B 線確診閾值。在資源充足的醫療機構就診的患者應接受脈搏血氧飽和度測定、胸部 X 光平片和心電圖檢查。在適當的臨床情況下，低氧血症以及單側或雙側瀰漫性肺泡陰影的存在足以確診。通常僅當初步評估無法得出明確結論或鑑別診斷中仍存在其他問題時才需要進行胸部電腦斷層掃描和超音波心動圖檢查。
應考慮高山呼吸道症狀的其他原因，如氣喘、支氣管痙攣、黏液栓、肺炎、氣胸、肺栓塞、病毒性上呼吸道感染、心臟衰竭或心肌梗塞。
Suggested Approach to the Diagnosis of HAPE
The diagnosis of HAPE requires a very specific clinical context–an unacclimatized lowlander ascending to elevations ≥2500 m–and relies on a characteristic set of symptoms, including dyspnea on exertion out of proportion to previous experiences at high altitude or that experienced by other individuals at the same elevation. Nonproductive cough, fatigue, weakness, and gurgling sensation in the chest may also be present. With progression, individuals become dyspneic with mild exertion or at rest and may develop cyanosis and cough productive of pink frothy sputum.
The setting in which the individual presents for evaluation influences the diagnostic approach. In the field environment, where diagnostic resources are limited, diagnosis may be made on the basis of history alone. If available, pulse oximetry can confirm the presence of hypoxemia out of proportion to that expected for a given elevation,123 a key feature for distinguishing HAPE from other sources of dyspnea, such as anxiety or poor physical conditioning, although care must be taken to avoid some of the pitfalls of such measurements at high altitude.124 Identification of B-lines on portable ultrasound is a sensitive but nonspecific diagnostic tool,125,126 but there is currently no accepted threshold for the number of B-lines necessary to confirm diagnosis. Individuals presenting to well-resourced health facilities should undergo pulse oximetry, plain chest radiography, and electrocardiography. The presence of hypoxemia and either unilateral or diffuse bilateral alveolar opacities on plain chest radiography is sufficient to confirm the diagnosis in the appropriate clinical context. Chest computed tomography scanning and echocardiography are generally only warranted when the initial evaluation is unrevealing or other problems remain high on the differential diagnosis.
Consideration should be given to other causes of respiratory symptoms at high altitude, such as asthma, bronchospasm, mucous plugging, pneumonia, pneumothorax, pulmonary embolism, viral upper respiratory tract infection, heart failure, or myocardial infarction.
個體就診的環境會影響診斷方法。在診斷資源有限的野外環境中，診斷可能僅基於病史。如果條件允許，脈搏血氧飽和度測定可以確認是否存在與特定海拔高度預期值不成比例的低氧血症，123 這是區分高海拔肺水腫 (HAPE) 與其他呼吸困難原因（例如焦慮或身體狀況不佳）的關鍵特徵，但必須注意避免在高海拔地區進行此類測量時可能出現的一些隱患。 124 便攜式超音波設備識別 B 線是一種敏感但不具特異性的診斷工具，125,126 但目前尚無公認的 B 線確診閾值。在資源充足的醫療機構就診的患者應接受脈搏血氧飽和度測定、胸部 X 光平片和心電圖檢查。在適當的臨床情況下，低氧血症以及單側或雙側瀰漫性肺泡陰影的存在足以確診。通常僅當初步評估無法得出明確結論或鑑別診斷中仍存在其他問題時才需要進行胸部電腦斷層掃描和超音波心動圖檢查。
應考慮高山呼吸道症狀的其他原因，如氣喘、支氣管痙攣、黏液栓、肺炎、氣胸、肺栓塞、病毒性上呼吸道感染、心臟衰竭或心肌梗塞。
Suggested Approach to the Diagnosis of HAPE
The diagnosis of HAPE requires a very specific clinical context–an unacclimatized lowlander ascending to elevations ≥2500 m–and relies on a characteristic set of symptoms, including dyspnea on exertion out of proportion to previous experiences at high altitude or that experienced by other individuals at the same elevation. Nonproductive cough, fatigue, weakness, and gurgling sensation in the chest may also be present. With progression, individuals become dyspneic with mild exertion or at rest and may develop cyanosis and cough productive of pink frothy sputum.
The setting in which the individual presents for evaluation influences the diagnostic approach. In the field environment, where diagnostic resources are limited, diagnosis may be made on the basis of history alone. If available, pulse oximetry can confirm the presence of hypoxemia out of proportion to that expected for a given elevation,123 a key feature for distinguishing HAPE from other sources of dyspnea, such as anxiety or poor physical conditioning, although care must be taken to avoid some of the pitfalls of such measurements at high altitude.124 Identification of B-lines on portable ultrasound is a sensitive but nonspecific diagnostic tool,125,126 but there is currently no accepted threshold for the number of B-lines necessary to confirm diagnosis. Individuals presenting to well-resourced health facilities should undergo pulse oximetry, plain chest radiography, and electrocardiography. The presence of hypoxemia and either unilateral or diffuse bilateral alveolar opacities on plain chest radiography is sufficient to confirm the diagnosis in the appropriate clinical context. Chest computed tomography scanning and echocardiography are generally only warranted when the initial evaluation is unrevealing or other problems remain high on the differential diagnosis.
Consideration should be given to other causes of respiratory symptoms at high altitude, such as asthma, bronchospasm, mucous plugging, pneumonia, pneumothorax, pulmonary embolism, viral upper respiratory tract infection, heart failure, or myocardial infarction.
沒有留言:
張貼留言