野外與登山醫學-高海拔肺水腫HAPE診斷-from CDC

2025-09-26 08:53AM
參考資料.美國疾管局-高海拔旅遊及疾病 CDC-High-Altitude Travel and Altitude Illness

診斷
早期診斷至關重要；高海拔肺水腫 (HAPE) 比高海拔腦水腫 (HACE) 更容易致命。初期症狀包括胸悶、咳嗽、運動時呼吸困難加劇、運動能力下降。如果未確診和治療，HAPE 會進展為靜止時呼吸困難和明顯的呼吸窘迫，常伴隨血痰。這種典型的 1-2 天進展很容易被識別為高海拔肺水腫，但對於通氣反應較差的患者，該病症可能僅表現為中樞神經系統功能障礙，伴隨意識模糊和嗜睡，且 SpO2較低。

大多數患者可聞及羅音。脈搏血氧飽和度測定有助於診斷；血氧飽和值常見於50%-70%，比同海拔健康族群至少低10個百分點。高山性肺水腫的鑑別診斷包括支氣管痙攣、心肌梗塞、心臟衰竭、肺炎和肺栓塞。


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 in those with poor ventilatory response may present only as central nervous system dysfunction, with confusion and drowsiness, while SpO2 is quite low.

Rales are detectable in most victims. Pulse oximetry can aid in making the diagnosis; oxygen saturation values of 50–70% are common, which are at least 10 points lower than in healthy people at the same altitude. The differential diagnosis for HAPE includes bronchospasm, myocardial infarction, heart failure, pneumonia, and pulmonary embolism.