野外與登山醫學-2025年野外燒燙傷處置臨床指引

2026-01-28 08:07AM

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2025年野外燒燙傷處置臨床指引

筆記:燒燙傷-沖水 from uptodate Dec 2025

燒燙傷三小時內沖冷水20分鐘可降低需植皮和手術治療的機率

Wilderness Medical Society Clinical Practice Guideline on Care of Burns in the Wilderness (WEM volume 36 Issue 4, December 2025)

這篇指引是給醫護人員看的. 一般民眾可能不容易理解, 有些

重點整理.主要針對到院前的處置

1. 燒傷創面冷卻療法(Cooling of burn wounds), 燒傷面積小於體表面積10%（TBSA）的，儘快用12至18°C（53至64°F）的水沖洗20至30分鐘。 

2. 如果沒有流動的水，也可浸泡在冷水中。

3. 在受傷後60分鐘內開始冷水療法(Cool water therapy)，仍然有效。

4. 冷水療法可減少燒傷深度、體表面積燒傷面積（TBSA）降低、植皮需求減少、癒合時間縮短, 也有助於控制疼痛。

5. 多數情況, 水泡若能保持完整儘量不弄破. 維持水泡完整可降低感染率.可減少疼痛. 已經破裂的水泡或很可能破裂的水泡可清除. 用針抽吸(aspiration)水泡內的液體或者將水泡整個移除(去頂)各有優缺點. 細針抽吸引流可以避免水泡自己破裂, 避免傷口受到汙染. 恢復較快(水泡能維持傷口濕度,也有物理性保護的效果)

6. 淺層二度燒燙傷可使用吸水性泡棉敷料

7. 深二度燒燙傷可使用抗生素藥膏或蜂蜜(指引內容說支持使用蜂蜜的文獻很多); 抗生素軟膏優於過去常使用的磺胺銀. 若12-24小時內可送到醫院則不用先塗藥膏(藥膏是為了降低未來一兩天的感染)

(其他可作為臨時燒燙傷敷料的東西包括:綠茶、木瓜醬、獼猴桃、薑黃和椰子油.可生物降解的臨時基質、聚乳酸皮膚替代物、透明質酸酯基質和去細胞魚皮移植片)

(中文使用google翻譯)
摘要
為了指導臨床醫生在偏遠地區護理燒傷患者的最佳實踐，荒野醫學會召集了一個專家小組，制定了一份基於循證醫學的臨床實踐指南。指南提出了現場緊急護理的建議，並根據美國胸腔科醫師學會的標準，對支持性證據的品質以及治療風險和潛在危害的平衡性進行分級。

引言
全球每年有超過800萬人因燒傷而受傷，其中18萬人死亡，低收入和中等收入國家的疾病負擔最為沉重。 燒傷佔荒野地區所有傷害的2%至9%。面積較小、傷情較淺的燒傷通常可以順利癒合，並在現場進行處理，但重度燒傷患者需要轉運。本實踐指引旨在降低野外及其他資源匱乏地區燒傷患者的發生率。它側重於偏遠地區燒傷患者護理的特殊方面，並非旨在取代關於燒傷患者護理的一般知識。

方法：
我們在PubMed資料庫中檢索了一系列文獻，主題包括初步穩定、燒傷急救、燒傷面積和深度的評估、水皰的處理、液體復甦、燒傷敷料、疼痛管理、疏散以及遠距醫療的應用。文章由專家小組進行審查，並根據其在艱苦環境下的適用性進行優先排序，然後根據證據強度進行分級。證據強度分級採用美國胸腔科醫學會（ACPC）的分類方案。 對於證據薄弱或缺失的主題，我們參考了野外和燒傷專科醫生的專業知識來補充建議。

現場評估：
初步評估：
在確保現場安全後，對燒傷患者的初步評估遵循創傷復甦的典型優先順序。13,14燒傷通常外觀觸目驚心，若未對患者進行系統性評估，則可能遺漏其他嚴重病灶。該評估應遵循 ABCDE 原則，即氣道、呼吸、循環、功能障礙以及暴露和環境控制。 燒傷患者氣道管理的傳統指徵包括鼻毛燒焦、口腔或痰液中有煙灰、聲音沙啞、喘鳴或明顯呼吸困難。 
有鑑於許多在到達燒傷中心前接受氣管插管的患者可能並不需要插管，促使美國燒傷協會提出了更嚴格的插管標準：對於出現氣道阻塞症狀（如聲音沙啞或喘鳴）、全層面部燒傷、呼吸窘迫、上呼吸道創傷、無法清除分泌物、精神狀態改變、低氧血症、高碳酸血症或血流動力學不穩定的患者，應進行氣管插管。目前尚缺乏足夠的證據指導在燒傷患者中使用鼻咽通氣道或聲門上通氣道，但如果氣道管理的指徵是上呼吸道水腫，則這些通氣道可能無效。 曾有報導稱，一名被雷擊的患者成功接受了現場環甲膜切開術。  如果具備適當的藥物和設備（包括鎮靜劑和可能的肌肉鬆弛劑），則應為有現場氣道管理指徵的患者進行氣管插管。如果患者有插管指徵，但現場沒有進行經口或經鼻氣管插管的設備，則可能需要建立外科氣道。現場氣道管理難度極高，可能需要等待具備高階氣道管理技能、設備和藥物的救援人員。
燒傷患者通常不會出現精神狀態改變，一旦出現，應進一步評估其原因，例如低血壓、頭部損傷或吸入性中毒。雖然最近的一例病例報告對這一傳統觀念提出了挑戰，但人們通常認為露天火災中吸入性損傷和吸入性中毒的情況很少見。該病例報告描述了一名燒傷死亡患者，他在自家院子裡焚燒灌木和生活垃圾時，吸入了致命濃度的一氧化碳和可測量的氰化物。吸入性損傷是由暴露於火焰或過熱氣體、顆粒物和化學刺激物以及吸入煙霧和肺組織局部缺氧引起的。 露天火災中的熱和煙霧往往會消散。
一氧化碳和氰化物是火災中可能存在的特定吸入性毒素，會導致患者精神狀態改變。一氧化碳中毒的典型症狀是精神狀態改變，少數患者會出現典型的櫻桃紅唇。 治療方法是將病人轉移到空氣流通的地方，並在條件允許的情況下給予氧氣。在房屋火災中，氰化物會從家具墊和地毯等合成材料的燃燒中釋放出來，但氰化物也會從塑膠、乙烯基、紙張和羊毛等戶外休閒用品的燃燒中釋放出來。 補充氧氣有助於氰化物中毒的治療，而根治性治療方法是給予氰鈷胺素或硫代硫酸鈉合併亞硝酸鈉。
燒傷患者的低血壓繼發於血管內液體滲漏至細胞外間隙或第三間隙，通常在初始損傷後 6 至 12 小時才會出現，因此，在初步評估期間發現低血壓需要評估是否存在其他創傷。

建議：

我們建議燒傷患者的初步評估應遵循創傷照護的一般原則。

等級：強烈推薦，高品質證據。
我們建議對燒傷後早期出現精神狀態改變或低血壓的患者進行評估，以排除其他病因。

等級：強烈推薦，中等品質證據。

急救
衣物可能繼續陰燃，因此應立即撲滅任何明火，並將燒焦的衣物從患者身上移除。應移除所有肢體上的首飾和任何可能隨著時間推移而收緊或束縛的物品，並進行仔細的血管檢查。
燒傷創面冷卻療法已應用數百年。燒傷面積小於體表面積10%（TBSA）的，應在燒傷發生後儘快用12至18°C（53至64°F）的水沖洗20至30分鐘。 如果 沒有自來水，浸泡在冷水中也是可以接受的。如果在受傷後60分鐘內開始冷水療法，仍然有效。飲用水優於未經處理的地表水，但使用未經處理的水會增加感染風險的證據很少。不應使用冰，因為在豬模型中，與冰相比，冷水能更快促進上皮再生。 我們沒有找到關於使用雪的證據，但不建議直接將雪敷於燒傷創面，因為雪的性質與冰相似。但是，雪可以用來冷卻治療用水。冷水療法的使用與燒傷深度減少、體表面積燒傷面積（TBSA）降低、植皮需求減少、癒合時間縮短有關。 冷水療法也有助於控制疼痛。體溫過低在體表面積燒傷面積較大的患者中更為常見，且與死亡率升高有關。其他體溫過低的危險因子包括現場停留時間延長、年齡較大、需要氣道管理、精神狀態改變。目前尚無充分證據支持在現場安全降溫的最大體表面積。救援人員應權衡在環境條件和預計到達最終治療地點所需時間下發生體溫過低的風險，以及如果不進行冷水療法治療，更大或更深的傷口可能導致更高的發病率。

建議
我們建議將燒傷面積小於體表面積10%的傷口用涼水沖洗20分鐘。 

等級： 強烈推薦，證據品質中等。
我們建議，如果存在體溫過低的風險，則不應在現場對燒傷部位進行冷卻。

等級： 弱推薦，低品質證據

燒傷深度分類
最淺的燒傷被歸類為表皮燒傷。這類燒傷僅涉及表皮最外層。皮膚會發紅，觸感發熱。不會形成水皰，皮膚乾燥。由於未損傷深層的神經血管結構，這類傷口往往非常疼痛。表皮燒傷通常在受傷後一週內癒合，且不會留下疤痕。
根據感染風險和預期癒合情況，部分厚度燒傷可分為 2 個不同的類別。
表淺部分皮質燒傷後，真皮和表皮之間會在燒傷發生後的12至24小時內形成水皰。這些水皰通常較薄，容易自發性破裂。水皰破裂後，其下方的皮膚會濕潤滲液，受壓後容易變白。由於下方的組織結構未受損，因此這類傷口會非常疼痛。淺層部分皮質燒傷通常會在7至21天內癒合，很少會留下明顯的疤痕。由於水皰會在受傷後的最初幾天內形成，因此隨著燒傷的進展，定期評估傷口情況並根據傷口的變化重新計算燒傷面積非常重要。 
深度二度燒傷涉及真皮深層，損傷毛囊和腺體組織。傷口呈濕潤或蠟狀，顏色斑駁，表面覆蓋焦痂。這類深層傷口比前文討論的淺層燒傷感染風險更高。預計自癒需要3至9週，且常伴隨增生性瘢痕。這類傷口需要專業的燒傷中心進行治療。
全層燒傷涉及表皮和真皮的所有層次，並延伸至皮下組織。這類傷口會導致皮下組織的神經血管結構受損，全層燒傷區域通常感覺喪失。初次評估時，燒傷焦痂通常仍完整，呈現黑色或皮革狀覆蓋。這類傷口無法自愈，需要由燒傷專科醫生進行切除和處理，以最大程度地減少攣縮和疤痕形成。
四度燒傷的特徵是筋膜、肌肉、肌腱和骨骼都受損。這種情況通常會導致肢體截肢，並且同樣需要專門的燒傷護理。

燒燙傷面積估算
燒燙傷面積的評估是燒傷患者初期照護的關鍵步驟。

體表面積百分比（%TBSA）的估算是基於淺二度燒傷、深二度燒傷和全層燒傷的面積。完整皮膚區域必須密切監測其轉化情況，但只有當傷口轉化為二度燒傷（以水皰形成為標誌）時，才將其計入體表面積百分比。
燒傷面積估算方法有多種。 「九分法」常用於成人，兒童和嬰兒則有改良版（圖1）。倫德-布勞德圖表以圖形方式呈現燒傷面積。 「手掌法則」指出，患者手掌（包括手指）的面積約佔其體表面積的1%。  此方法便於現場操作，但往往會高估燒傷面積，尤其當燒傷面積超過體表面積的10%時。 
圖1.成人和嬰兒燒傷面積估算的「九分法」。經美國燒傷協會許可使用。
目前市面上有一些以智慧型手機為基礎的燒傷面積計算器，可以輔助計算燒傷面積。這些計算器是基於“九分法”計算，並且適用於成人。它們還可以根據計算出的燒傷面積百分比（%TBSA）和患者體重，提供燒傷液復甦建議。
對燒傷患者進行精確的體表面積燒傷百分比（%TBSA）評估至關重要，因為它決定了初始復甦液輸注速度和轉運決策。現場對燒傷面積的估計並不完全可靠，因為醫護人員常常高估%TBSA，尤其是兒童病患。
推薦
我們建議採用經過驗證的方法計算體表面積燒傷百分比（%TBSA），以指導復甦和轉運決策。 等級： 強烈推薦，證據品質中等。

水泡管理
目前缺乏指導野外水皰處理的實證醫學證據。最大的爭議在於是否應保留水皰完整，還是應在切除或不切除水皰頂部的情況下排出水皰內的液體。水皰內的液體是無菌的，能夠提供濕潤的環境，促進傷口癒合和上皮化。然而，水皰液中含有血栓素和其他發炎介質，這些物質會導致血管收縮，並可能幹擾傷口癒合。 1987 年的一項直接對比研究表明，與清創相比，保留水皰可以減少細菌定植並更好地控制疼痛。2020 年， 《急診醫學年鑑》 發表了一篇題為「臨床爭議」的文章，探討了早期住院治療中清創的利弊。在野外或其他資源匱乏的環境中，感染控制和疼痛控制都至關重要。
另一種治療水皰的方法是抽吸水皰液。 Ro 等人比較了抽吸和去頂兩種治療方法，發現兩種方法各有優劣，但在某些傷口癒合方面，抽吸組更勝一籌。抽吸便於水皰的包紮，並可能防止水皰自發性破裂，從而避免潛在的污染。

建議
我們建議在大多數情況下不要處理水皰。 

等級： 弱推薦，證據品質低。
我們建議對已破裂的水皰和可能自發性破裂的大水皰進行清創。 

推薦等級： 弱推薦，證據品質中等。
如果水皰限制了關節活動或位於難以自行排出的位置，我們建議透過小窗口進行抽吸或引流。 

推薦等級： 弱推薦，證據品質低。

液體復甦

燒傷面積達到體表面積的20%或以上可導致休克，液體復甦是挽救生命的措施。目前有許多燒傷復甦公式，尚無普遍接受的公式。液體復甦是一個動態過程，需要頻繁評估患者是否有終末器官灌注不足的跡象，並謹慎地調整液體輸注量。如果液體復甦不足或延遲，可能導致組織流失增加、休克、多重器官衰竭甚至死亡。如果液體復甦過度，毛細血管滲漏會導致水腫，並可能引起成人呼吸窘迫症候群、筋膜室症候群和其他併發症。任何等滲液體均可用於院前液體復甦，但首選平衡溶液， 例如乳酸林格氏液。 避免這些併發症的關鍵在於準確評估燒傷面積。一些智慧型手機應用程式也有助於評估燒傷患者的液體需求。

美國燒傷協會建議如下：
•對於燒傷面積小於 20% 的體表面積燒傷，口服復甦是合適的，因為這些燒傷不會引起嚴重的全身性發炎、水腫的快速形成或未燒傷組織的血管擴張。
•燒傷面積達到體表面積的 20% 或以上的成人和兒童應進行靜脈輸液進行容量復甦。
•許多常用的公式估計，在最初 24 小時內，晶體液的需求量為 2 至 4 mL·kg –1 體重/%TBSA。
•液體復甦應依成人尿量調整，以維持尿量為 0.5 至 1.0 mL·kg –1 ·h –1 ， 兒童尿量為 1 至 1.5 mL·kg –1 ·h –1 。
•某些人群預計會增加液體需求，例如全層燒傷患者、吸入性損傷患者、橫紋肌溶解症患者以及復甦延遲的患者。
•對於沒有輸液幫浦的院前急救人員來說，嬰兒每分鐘滴注 20 滴（60 mL·h –1），兒童患者每分鐘滴注 40 滴（約 125 mL·h –1），成人每分鐘滴注 80 滴都是合理的。
在資源匱乏的環境中，對於燒傷面積達體表面積40%的患者，已採用口服補液療法。 口服補液鹽可使用市售產品配製，也可自行配製（表1）。如無法取得市售產品，可使用添加鹽的「安全」當地飲料或補充鹽片，但總鈉含量不得超過口服補液鹽的建議量。鈉攝取過量可能導致噁心和嘔吐。口服補液速度應與預期的靜脈輸液速度相符。如果患者無法耐受所需的口服液體量，可插入鼻胃管輔助輸液。在極端情況下，如果無法透過其他途徑輸液，可將液體注入皮下組織或透過直腸灌注（稱為直腸灌注）進行 輸液。69 如果無法正式測量尿量且疏散延遲，救援人員應滴定輸液，使受害者產生大量淡黃色尿液。
表 1.口服補液鹽配方。
世界衛生組織配方簡單公式1公升清水 1公升清水
6茶匙糖 6茶匙糖
3/8 茶匙鹽 ½ 茶匙鹽
¼ 茶匙代鹽（氯化鉀）
½ 茶匙小蘇打

建議
我們建議對體表面積燒傷面積小於20%的燒傷患者進行口服補液復甦。 

推薦等級： 強烈推薦，證據品質中等。
我們建議，對於燒傷面積超過體表面積20%的患者，如果條件允許，應立即開始靜脈輸液復甦。 

等級： 強烈推薦，高品質證據。
考慮到現場救護的限制，我們建議以 2 mL·kg⁻¹/%TBSA 的劑量作為起始劑量。

推薦等級： 弱推薦，證據品質中等。
我們建議，對於燒傷面積不超過體表面積40%的燒傷，口服補液可能就足夠了。

推薦等級： 弱推薦，證據品質中等。
我們建議在極端情況下可採用其他途徑進行液體復甦，包括鼻胃管、皮下浸潤和直腸灌注。 

推薦等級： 弱推薦，證據品質中等。
我們建議監測患者的容量狀態，並根據需要調整輸液量。 

等級： 強烈推薦，證據品質中等。

燒傷敷料
磺胺嘧啶銀曾長期是燒傷敷料的標準治療方法，但現在已被抗生素軟膏基本取代。抗生素軟膏的療效與磺胺嘧啶銀相當甚至更佳，而且更常被納入急救箱。如果到最終治療的時間少於12至24小時，則無需使用抗生素軟膏或特殊敷料。吸水性泡棉敷料，如Mepilex™（Mölnlycke Health Care，Peachtree Corners，GA），適用於表淺部分厚度燒傷，可留置長達1週，從而最大限度地減少換藥帶來的疼痛。水凝膠敷料在燒傷癒合方面顯示出良好的前景，並且無需處方即可購買。大量文獻支持使用蜂蜜作為臨時燒傷敷料。其他一些在資源匱乏地區可能可用的、具有動物或體外療效證據的物質包括綠茶、木瓜醬、獼猴桃、薑黃和椰子油。74-76 這些敷料可用於紗布或不沾鍋敷料下。其他建議在偏遠地區使用的敷料包括可生物降解的臨時基質、聚乳酸皮膚替代物、透明質酸酯基質和去細胞魚皮移植片。 77如果無法取得 專用敷料，任何乾淨乾燥的布料均可用於覆蓋傷口。
雖然局部應用抗生素可以減少細菌定植和感染風險，但不應預防性使用口服或全身性抗生素。預防性使用抗生素可能會增加日後感染抗藥性細菌的風險。
建議
我們建議對淺層部分皮層燒傷使用吸水性泡棉敷料。 推薦等級： 弱推薦，證據品質中等。
如果現場處理或撤離會延誤，我們建議對深度二度燒傷患者使用抗生素軟膏或蜂蜜。 等級： 強烈推薦，證據品質中等。
我們認為，與其它類型的敷料相比，吸水泡棉敷料可能更易於現場操作。 推薦等級： 弱推薦，證據品質中等。
鎮痛
對於小面積或表淺燒傷，非處方鎮痛藥如對乙醯氨基酚和非類固醇類抗發炎藥物可能就足夠了，應作為多模式鎮痛方案的一部分，用於所有無禁忌症的患者。然而，燒傷疼痛劇烈，患者可能需要處方止痛藥。 ⁸⁰ 充分控制疼痛與較低的心理後遺症發生率有關。^81,82在超急性期， 冷敷傷口有助於控制疼痛。⁸³ 由於擔心全身吸收可能導致毒性，局部使用利多卡因存在爭議，但它可能對小面積燒傷有效。 ⁸⁴ 催眠、音樂療法和虛擬實境等輔助療法已在住院環境中應用，但尚無關於這些幹預措施在院前環境中有效性的數據。85-87鴉片 類藥物是住院病患疼痛控制的主要手段，而氯胺酮廣泛用於手術疼痛和減少鴉片類藥物的使用。 80野外醫學會發布的《偏遠地區急性疼痛治療​​臨床實踐指南》 對野外鎮痛藥物和輔助用藥進行了全面的綜述。 88
建議
我們建議先使用非處方止痛藥來治療疼痛。 等級： 強烈推薦，證據品質中等。
我們建議使用鴉片類藥物或氯胺酮等輔助藥物來控制疼痛（如有條件）。 等級： 強烈推薦，證據品質中等。
急救箱
野外急救包中的許多物品都有助於治療燒傷，例如抗生素軟膏、無菌敷料、補液鹽和止痛藥。對於燒傷風險較高的探險隊，可以考慮攜帶更多物品，例如靜脈輸液、水凝膠敷料以及麻醉劑或其他高級止痛藥。
燒傷患者的疏散
目前尚缺乏足夠的證據來指導哪些類型的燒傷需要轉運。野外醫學會傷口管理指南引用了 1C 級證據，指出對於以下需要更高水平護理（野外環境無法提供）的燒傷患者，應進行轉運⁸⁹：
•
氣道或吸入性損傷
•
胸部燒傷導致通氣功能受損
•
手、腳、生殖器、黏膜或臉部嚴重燒傷
•
環週燒傷，包括部分或全層燒傷。
•
燒傷面積超過體表面積5%的全層燒傷
•
體表面積超過10%至20%的部分厚度燒傷
•
感染性燒傷
•
燒傷伴隨無法控制的疼痛
•
雷擊傷
•
電燒傷
•
化學灼傷
此外，我們建議，如果出現以下情況，應加快疏散速度：
•
眼睛灼傷，導致視力受損或異物感；
•
任何需要現場進行高級氣道管理的燒傷；
•
任何需要現場焦痂切開術或筋膜切開術的燒傷；
•
即將出現筋膜室症候群的跡象；
•
嚴重創傷引起的燒傷；
•
燒傷時尿量減少（<30–50 mL·h –1）；
•
其他灌注減少的跡象（例如，精神狀態改變、活動減少、皮膚彈性下降、眼窩凹陷等）；
•
燒傷伴隨低體溫；
•
深度部分或全層燒傷，燒傷面積大於體表面積的 5%；
•
淺層部分燒傷，燒傷面積大於體表面積的 10% 至 20%；
•
關節處部分或全層燒傷；
•
嬰兒（<2 歲）燒傷面積超過體表面積 5%；
•
疑似一氧化碳或氰化物中毒引起的燒傷；
•
燒傷導致受害者無法繼續在現場活動。
這意味著大多數燒傷患者需要撤離，只有輕微燒傷才適合嘗試現場救治。
轉運前應進行充分的穩定處理，包括開始液體復甦、確保氣道通暢（如有必要）以及骨折固定。轉運過程中應繼續治療，包括監測生命徵象和精神狀態、鎮痛以及調整液體復甦劑量。可使用低溫包裹來預防體溫過低。^{90 , 91} 如果到達最終治療的時間不足24小時，燒傷敷料應保持完整。如果轉運延遲，可能需要重新檢查傷口，觀察燒傷深度是否加深或是否有感染跡象。
遠距醫療
遠距醫療已被證明能夠提高燒傷面積的評估準確性，從而降低燒傷患者過度分診和分診不足的發生率。遠距醫療還能提高燒傷治療資源的使用率。 92-96
推薦
我們建議使用遠距醫療來促進現場救護。 等級： 強烈推薦，證據品質中等。
結論
這些指南是基於實證醫學的建議，旨在為野外和其他條件艱苦環境下的燒傷患者提供護理。現場燒傷患者的照護必須考慮傷情嚴重程度、可用資源、環境條件以及到達最終治療機構的時間/距離。

Abstract
To provide guidance to clinicians about best practices in caring for burn patients in remote settings, the Wilderness Medical Society convened an expert panel to develop an evidence-based clinical practice guideline. Recommendations for field-expedient care are made, with recommendations being graded using the American College of Chest Physicians criteria for the quality of supporting evidence and balance of risks and potential harms of treatment.

Introduction
Globally, burns cause >8 million injuries annually with 180,000 deaths, with the highest burden of disease in low- and middle-income countries.1–3 Burns account for 2 to 9% of injuries occurring in the wilderness.4–11 Burns that are small and superficial generally will heal uneventfully and can be managed in the field, but patients with more severe burns require evacuation. The goal of this practice guideline is to reduce the morbidity of burn injuries sustained in the wilderness and other low-resource settings. It focuses on unique aspects of care of burned patients in the remote settings and is not intended to replace general knowledge about care of burned patients.
Methods
A series of literature reviews was conducted in PubMed on topics including initial stabilization, burn first aid, estimating size and depth of burns, management of blisters, fluid resuscitation, burn dressings, pain management, evacuation, and use of telemedicine. Articles were reviewed by a panel of experts and prioritized based on applicability in the austere setting and then graded on the strength of evidence. The American College of Chest Physicians classification scheme was used to grade the strength of the evidence.12 The expertise of wilderness and burn practitioners was used to supplement recommendations for topics where the evidence was weak or nonexistent.
Field Assessment
Initial Evaluation
After ensuring that the scene is safe, the initial evaluation of the burn patient follows the typical priorities of trauma resuscitation.13,14 Burns are often visually impressive, and other serious pathology may be missed if a methodical evaluation of the patient is not completed. This evaluation should follow the ABCDE format of airway, breathing, circulation, disability, and exposure and environmental control.14
Traditional indications for airway management in burn patients include singed nasal hair, soot in the mouth or sputum, hoarse voice, stridor, or significant dyspnea.15 Recognition that many patients intubated prior to arrival at a burn center may not have required intubation led to stricter criteria being proposed by the American Burn Association: Intubation should be performed for patients with signs of airway obstruction such as hoarseness or stridor, full-thickness facial burns, respiratory distress, upper airway trauma, inability to clear secretions, altered mentation, hypoxia, hypercarbia, or hemodynamic instability.14,16,17 There is little evidence to guide the use of nasopharyngeal or supraglottic airways in burn patients, but they may fail if the indication for airway management is upper airway edema.18 Successful field cricothyroidotomy was described for a patient who sustained a lightning strike.19 Patients with indications for airway management in the field should be intubated if appropriate medications and equipment are available, including sedation and, potentially, paralytics. A surgical airway may be required if patients have indications for intubation and equipment is not available to perform oral or nasal endotracheal intubation. Field airway management is fraught with difficulty and may require awaiting rescue personnel with advanced airway skills, equipment, and medication.
Altered mental status is not an expected finding in burn injuries, and its presence should prompt further evaluation for its etiology, such as hypotension, head injury, or toxic inhalation. Inhalation injury and toxic inhalations are considered rare in open-space fires, although a recent case report has challenged this dogma. It describes a lethal level of carbon monoxide and measurable cyanide in a burn fatality patient who was burning brush and household debris in his yard.20 Inhalation injuries are caused by heat from exposure to flame or superheated gas, particulate matter, and chemical irritants inhaled with smoke and local hypoxia in the pulmonary tissue.21 Heat and smoke tend to dissipate in open-space fires.
Carbon monoxide and cyanide are specific inhalation toxins that may be present in fires and cause patients to have altered mental status. Carbon monoxide toxicity presents with altered mental status, with the classic cherry red lips seen in a minority of patients.22,23 Treatment is moving the patient to open air with oxygen administration, if available. In house fires, cyanide is released from burning of synthetic materials such as furniture cushions and carpet, but cyanide is also released from combustion of outdoor recreation supplies such as plastics, vinyl, paper, and wool.24 Supplemental oxygen is helpful in cyanide poisoning, and definitive treatment is administration of cyanocobalamin or sodium thiosulfate with sodium nitrite.
Hypotension in burn patients is secondary to extravasation of intravascular fluid into the extracellular or third-space compartment and does not typically result until 6 to 12 h after the initial injury, so hypotension during the initial evaluation requires evaluation for other traumatic injuries.25,26

Recommendations
We recommend that the initial evaluation of a burn patient follow general principles of trauma care. Grade: Strong recommendation, high-quality evidence.
We recommend that patients with altered mental status or hypotension in the immediate postburn period be evaluated for other etiologies of these findings. Grade: Strong recommendation, moderate-quality evidence.

First Aid
Clothing may continue to smolder, so any ongoing fire should be extinguished and burned material should be removed from patients. Jewelry and any items that may tighten or constrict over time should be removed from all extremities, and a careful vascular exam should be performed.
Cooling of burn wounds has been used for centuries.27 Burns of <10% total body surface area (TBSA) should be irrigated with water that is 12 to 18°C (53–64°F) for 20 to 30 min, starting as soon as possible after the burn occurs.28–31 Immersion in cool water is acceptable if no running water is available. Cool water therapy remains effective if initiated within 60 min of injury.28,32 Potable water is preferred to untreated surface water, but there is little evidence regarding the risk of infection using untreated water. Ice should not be use because reepithelialization occurred more rapidly in a porcine model with cool water compared with ice.29 We found no evidence regarding use of snow but recommend against direct application of snow to burn wounds because its properties are similar to those of ice. However, snow may be used to cool water for treatment. Use of cool water therapy is associated with reduced burn depth, lower TBSA, less need for skin grafting, and shorter time to healing.33–43 Use of cool water therapy also may aid in pain control.44 Hypothermia is more common in patients with larger TBSA burns and is associated with increased mortality.45 Other risk factors for hypothermia include prolonged scene time, older age, need for airway management, and altered mental status.46 There is little evidence to support a maximum TBSA that can be safely cooled in the field. Rescue personnel should weigh the risk of hypothermia given environmental conditions and expected time to definitive care against the risk of increased morbidity from larger or deeper wounds if not treated with cool water therapy.
Recommendations
We recommend that burn wounds of <10% TBSA be irrigated with cool running water for 20 min. Grade: Strong recommendation, moderate-quality evidence.
We suggest that burns not be cooled in the field if there is a risk of hypothermia. Grade: Weak recommendation, low-quality evidence
Classification of Burn Depth
The shallowest burns are classified as superficial. These burns involve only the top layers of the epidermis. The skin will appear reddened and warm to the touch. There is no blister formation, and the skin is dry. These wounds tend to be very painful because there is no damage to the underlying neurovascular structures. Healing of superficial burns is expected within 1 wk of injury, and scarring is absent.
Classification of partial-thickness burns is divided into 2 separate categories based on their infection risk and expected healing.
Superficial partial-thickness burns form blisters between the dermis and epidermis within the first 12 to 24 h after the burn occurs. Superficial partial-thickness burns tend to have thin-roofed blisters that rupture spontaneously. When these blisters rupture, the underlying area will be wet and weeping and will blanch easily with pressure. Because the underlying structures are uninjured, these are intensely painful wounds. Superficial partial-thickness burns are expected to heal in 7 to 21 d and rarely cause significant scarring. Because blisters can be expected to form over the first few days after injury, it is important to periodically reassess wounds as the burn evolves and to recalculate your burn surface area based on conversion of the wound.47,48
Deep partial-thickness burns involve the deeper dermis, causing damage to the hair follicles and glandular tissue. The wound will appear wet or waxy with a mottled color and overlying eschar. These deeper wounds present a much higher infection risk than the more superficial burns discussed earlier. Spontaneous healing is expected to take 3 to 9 wk, and hypertrophic scarring is common. These wounds benefit from specialized burn center management.
Full-thickness burns involve all layers of the epidermis and dermis and extend into the subcutaneous tissues. These wounds result in damage to the neurovascular structures of the underlying tissue, and the areas of full-thickness burn are often insensate. On initial evaluation, the burn eschar is often still intact, presenting as a blackened or leathery covering. These wounds do not heal spontaneously and require excision and management by a burn specialist to minimize contracture formation and scarring.
Fourth-degree burns are characterized by injury involving the fascia, muscle, tendon, and bone. These often result in amputation of the extremity and, again, require specialized burn care.
Burn Size Estimation
Estimation of the burn size is a crucial step in the initial care of burn patients. %TBSA is estimated based on the amount of superficial partial-thickness, deep partial-thickness, and full-thickness burns. Areas of intact skin must be monitored carefully for conversion but are added to the TBSA only if the wound transforms into a partial-thickness burn, as evidenced by blister formation.
Several different methods of burn size estimation exist. The rule of 9’s is commonly used for adults, and a modified version is available for children and infants. (Figure 1). The Lund-Browder chart provides a graphical representation of burns. The rule of palms states that the patient's palm (including digits) is ∼1% of their body surface area.49 This method is expedient for field use but tends to overestimate burns, particularly if the burn is >10% TBSA.50
Figure 1. Rule of 9’s for burn size estimation in adults and infants. Used with permission of the American Burn Association.
Several smartphone-based calculators exist to assist in the calculation of burn size. These are based on the rule of 9’s and are adult specific. These calculators also may provide burn fluid resuscitation recommendations based on the %TBSA calculated and the patient's weight.
Careful estimation of the %TBSA is crucial in burn patients because it guides the initial resuscitation fluid rate and decisions regarding evacuation. Field estimation of burn size is not entirely reliable because providers often overestimate the %TBSA, especially in children.51–53
Recommendation
We recommend %TBSA burn be calculated using a validated method to guide resuscitation and evacuation decisions. Grade: Strong recommendation, moderate-quality evidence.
Blister Management
Evidence to guide management of blisters in the field is lacking. The biggest source of controversy is whether to leave the blister intact or to drain the fluid from the blister with or without removing the roof of the blister. The fluid within a blister is sterile, providing a moist environment that promotes wound healing and epithelialization. Conversely, blister fluid contains thromboxanes and other inflammatory mediators that cause vasoconstriction and may interfere with wound healing. A head-to-head comparison in 1987 showed decreased bacterial colonization and better pain control with intact blisters compared with debridement.54 Evidence for and against debridement during early hospital management was presented in a “Clinical Controversies” presentation in the Annals of Emergency Medicine in 2020.55,56 The concerns for both infection and pain control are of the utmost importance when in the wilderness or other resource-limited settings.
An alternative method of blister treatment is aspiration of the fluid. Ro et al57 compared aspiration with deroofing and found neither treatment to be superior, but some aspects of wound healing did favor the aspiration group. Aspiration allows for easier dressing of blisters and may prevent spontaneous rupture with potential contamination.
Recommendations
We suggest that blisters should be left intact in most situations. Grade: Weak recommendation, low-quality evidence.
We suggest debridement of ruptured blisters and large blisters that may rupture spontaneously. Grade: Weak recommendation, moderate-quality evidence.
We suggest aspiration or drainage of a blister through a small window if the blister is limiting movement of a joint or is in a location that would impede self-evacuation. Grade: Weak recommendation, low-quality evidence.
Fluid Resuscitation
Burns of 20% TBSA or greater can cause shock, and fluid resuscitation is a lifesaving intervention. Multiple formulas for burn resuscitation exist, and there is no universally accepted formula. Fluid resuscitation is a dynamic process that depends on frequent evaluation of the patient for signs of inadequate end-organ perfusion and careful titration of fluids.58 If fluid resuscitation is inadequate or delayed, increased tissue loss, shock, multiorgan system failure, and death may ensue. If fluid resuscitation is excessive, capillary leak leads to edema and may cause adult respiratory distress syndrome, compartment syndrome, and other complications.59,60 Any isotonic fluid is acceptable for prehospital fluid resuscitation, but a balanced solution such as lactated Ringer's solution is preferred.61 Avoidance of these complications starts with accurate burn size estimation. There are several smartphone applications that also may aid in estimation of fluid requirements for burn patients.62
The American Burn Association recommends the following63:
•
Oral resuscitation is appropriate for burns of <20% TBSA because these burns are not associated with severe systemic inflammation, rapid formation of edema, or vasodilation in unburned tissues.
•
Adults and children with burns of 20% TBSA or greater should undergo volume resuscitation with intravenous fluids.
•
Many of the common formulas estimate a crystalloid need in the first 24 h of 2 to 4 mL·kg–1 of body weight/%TBSA.
•
Fluid resuscitation should be titrated to maintain a urine output of 0.5 to 1.0 mL·kg–1·h–1 in adults and 1 to 1.5 mL·kg–1·h–1 in children.
•
Certain populations are expected to have increased fluid requirements, such as patients with full-thickness burns, inhalation injuries, or rhabdomyolysis and patients with delays in resuscitation.
•
For prehospital providers without pumps, drip rates of 20 drops/min for infants (60 mL·h–1), 40 drops/min for pediatric patients (∼125 mL·h–1), and 80 drops/min for adults are reasonable.
Oral fluid resuscitation has been used for burns up to 40% TBSA in low-resource settings.64–68 Oral rehydration solution may be prepared with commercial products or improvised (Table 1). When unavailable, “safe” local beverages with added salt or supplementation with salt tablets may be adequate as long as the total sodium content does not exceed oral rehydration solution recommendations.64 Excessive sodium may contribute to nausea and vomiting. The rate of oral fluid intake should match the predicted intravenous fluid resuscitation rate. If patients do not tolerate the necessary volumes of fluid by mouth, a nasogastric tube may be inserted to assist in fluid resuscitation. Under extreme circumstances, when fluids may not be administered via other routes, fluids may be instilled into the subcutaneous tissues or delivered by rectal infusion, known as proctoclysis.69 If it is not possible to formally measure urine output and evacuation is delayed, rescuers should titrate fluids so that the victim produces copious pale-yellow urine.
Table 1. Recipes for oral rehydration solution.

World Health Organization formulaSimple formula1 L clean water 1 L clean water
6 tsp sugar 6 tsp sugar
3/8 tsp salt ½ tsp salt
¼ tsp salt substitute (potassium chloride)
½ tsp baking soda

Recommendations
We recommend oral rehydration for resuscitation of burn injuries of <20% TBSA. Grade: Strong recommendation, moderate-quality evidence.
We recommend that intravenous fluid resuscitation be started, if available, for burns of >20% TBSA. Grade: Strong recommendation, high-quality evidence.
We suggest that starting with a rate of 2 mL·kg–1/%TBSA is reasonable given the constraints of field care. Grade: Weak recommendation, moderate-quality evidence.
We suggest that oral rehydration may be sufficient for burns of up to 40% TBSA. Grade: Weak recommendation, moderate-quality evidence.
We suggest that fluid resuscitation may proceed by alternate routes in extreme circumstances, including nasogastric tube, subcutaneous infiltration, and proctoclysis. Grade: Weak recommendation, moderate-quality evidence.
We recommend that the patient’s volume status should be monitored with titration of fluids as needed. Grade: Strong recommendation, moderate-quality evidence.
Burn Dressings
Silver sulfadiazine was long the standard of care for burn dressings but has largely been replaced by antibiotic ointment, which provides equivalent or better healing and is more likely to be included in a first aid kit.70,71 No antibiotic ointment or specialized dressing is required if time to definitive care is less than 12 to 24 h. Absorbent foam dressings such as Mepilex™ (Mölnlycke Health Care, Peachtree Corners, GA) are useful for superficial partial-thickness burns and may be left in place for up to 1 wk, minimizing the pain of dressing changes. Hydrogel dressings show promise in burn healing and are available over the counter.72 There is a significant body of literature to support the use of honey as an improvised burn dressing.73 Other agents with animal or in vitro evidence of efficacy that might be available in resource-limited settings include green tea, papaya paste, kiwifruit, turmeric, and coconut oil.74–76 These could be used under gauze or a nonstick dressing. Other dressings suggested for use in remote settings include biodegradable temporizing matrix, polylactic acid skin substitute, hyaluronic acid ester matrix, and decellularized fish skin graft.77 If specialized dressing materials are unavailable, any clean, dry cloth may be used to cover the wound.
Although topical antibiotics can reduce colonization and risk of infection, prophylactic oral or systemic antibiotics should not be used.78 Prophylactic antibiotics may increase the risk of later infection with resistant organisms.79
Recommendations
We recommend using absorbent foam dressings on superficial partial-thickness burns. Grade: Weak recommendation, moderate-quality evidence.
We recommend using antibiotic ointment or honey on deep partial-thickness burns if attempting field management or evacuation will be delayed. Grade: Strong recommendation, moderate-quality evidence.
We suggest that absorbent foam dressings may be easier to manage in the field than other types of dressings. Grade: Weak recommendation, moderate-quality evidence.
Analgesia
Over-the-counter analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs may be sufficient for small or superficial burns and should be used as part of multimodal pain relief in all patients without contraindications. However, burn injuries are incredibly painful, and patients may require prescription analgesics.80 Adequate control of pain has been associated with lower rates of psychological sequelae.81,82 Cooling the wound aids in pain control in the hyperacute phase.83 Use of topical lidocaine is controversial due to concern for toxicity owing to systemic absorption, but it may be useful in small burns.84 Adjuncts such as hypnosis, music therapy, and virtual reality have been used in the inpatient setting, but there are no data on effectiveness of these interventions in the prehospital setting.85–87 Opioids are the mainstay of pain control in hospitalized patients, and ketamine is widely used for procedural pain and opioid-sparing effects.80 The Wilderness Medical Society clinical practice guideline for the treatment of acute pain in remote environments provides a comprehensive review of analgesic medications and adjuncts for pain control in the field.88
Recommendations
We recommend over-the-counter analgesics as the initial treatment for pain. Grade: Strong recommendation, moderate quality evidence.
We recommend opioids or adjuncts such as ketamine to control pain, if available. Grade: Strong recommendation, moderate-quality evidence.
First Aid Kit
Many items included in a general wilderness first aid kit will be helpful in the treatment of burn injuries, including antibiotic ointment, sterile dressings, rehydration salts, and analgesics. Expeditions with an elevated risk of burn injuries may consider additional items such as intravenous fluids, hydrogel dressings, and narcotics or other advanced analgesics.
Evacuation of Burn Patients
There is little evidence to guide what types of burn injuries require evacuation. The Wilderness Medical Society wound management guidelines cite Level 1C evidence for evacuation of patients with the following burns that require higher levels of care not available in the wilderness setting89:
•
Airway or inhalational injury
•
Burns to the thorax that impair ventilation
•
Significant burns to hands, feet, genitals, mucous membranes, or face
•
Circumferential burns that are partial or full thickness
•
Full-thickness burns of >5% TBSA
•
Partial-thickness burns of >10 to 20% TBSA
•
Infected burns
•
Burns with uncontrolled pain
•
Lightning injuries
•
Electrical burns
•
Chemical burns
Additionally, we suggest evacuation be expedited if there are
•
burns to the eye that compromise vision or result in foreign-body sensation;
•
any burn that required advanced airway management in the field;
•
any burn that requires field escharotomy or fasciotomy;
•
signs of impending compartment syndrome;
•
burns associated with significant trauma;
•
decreased urine output in the setting of burns (<30–50 mL·h–1);
•
other signs of decreased perfusion (eg, change in mentation, inactivity, decreased skin turgor, sunken eyes, etc);
•
burns with associated hypothermia;
•
deep partial- or full-thickness burns of >5% TBSA;
•
superficial partial-thickness burns of >10 to 20% TBSA;
•
partial- or full-thickness burns over joints;
•
burns of >5% TBSA in infants (<2 y);
•
burns with suspicion of carbon monoxide or cyanide toxicity; and
•
burns that impair the victim's ability to remain active in the field.
This means that most burn patients will require evacuation, with only minor burns being appropriate for a trial of field management.
Adequate stabilization should occur prior to transport, including initiation of fluid resuscitation, securing the airway (if indicated), and splinting of fractures. Treatment should continue during evacuation, including monitoring of vital signs and mental status, analgesia, and titration of fluid resuscitation. A hypothermia wrap may be used to prevent hypothermia.90,91 If time to definitive care is <24 h, burn dressings should be left intact. Wounds may need to be rechecked for progression of burn depth or signs of infection if evacuation is delayed.
Telemedicine
Telemedicine has been shown to improve estimation of burn size, resulting in lower rates of over- and undertriage of burn patients. Telemedicine also improves resource utilization for burn care.92–96
Recommendation
We recommend use of telemedicine to facilitate field care. Grade: Strong recommendation, moderate-quality evidence.
Conclusion
These guidelines are evidence-based recommendations for providing care for burn patients in the wilderness and other austere settings. Care of burned patients in the field must consider severity of injury, available resources, environmental conditions, and time/distance to definitive care.

外傷-野外與登山醫學-燒燙傷三小時內沖冷水20分鐘可降低需植皮和手術治療的機率

2026-01-27 19:41
相關筆記
2025年野外燒燙傷處置臨床指引
筆記:燒燙傷-沖水 from uptodate Dec 2025
燒燙傷三小時內沖冷水20分鐘可降低需植皮和手術治療的機率

這篇研究說. 燙傷三小時內沖水20分鐘有效
The effect of 20 minutes of cool running water first aid within three hours of thermal burn injury on patient outcomes: A systematic review and meta-analysis
這篇研究發表於 Epub 2022 Jun 7.
作者 Bronwyn Griffin 1, C J Cabilan 2, Bassel Ayoub 3, Hui Grace Xu 4, Tina Palmieri 5, Roy Kimble 6, Yvonne Singer 7

摘要
背景： 

燒傷是導致患者發病的主要原因之一，可造成嚴重的殘疾，並顯著降低倖存者的生活品質。本系統性回顧旨在綜合分析相關證據，探討在燒傷後三小時內接受20分鐘冷水沖洗（CRW）對熱燒傷患者預後的影響。

方法： 本系統性回顧參照系統性回顧與Meta分析的首選報告條目（PRISMA）進行。檢索了多個資料庫（PubMed、EMBASE、CENTRAL、EBSCO的CINAHL Complete、PROQUEST學位論文資料庫）以及澳洲新西蘭臨床試驗註冊庫，納入符合條件的英文和中文文獻，未設日期限制。採用Downs和Black核對錶評估研究的方法學品質。

結果： 在檢索到的323筆記錄中，最終納入7篇研究。大多數研究（67%）在澳洲和紐西蘭進行。研究方法品質介於「一般」和「良好」之間。燒傷後三小時內進行20分鐘的CRW（冷水沖洗）可顯著降低患者需要植皮和手術治療的機率。

結論： 大量證據表明，在燒傷後三小時內進行20分鐘的冷水沖洗（CRW）能夠改善燒傷患者的預後。為了優化燒傷急救，從而改善全球患者的預後，燒傷組織之間需要共識，並開展合作，將實證實踐轉化為臨床應用。

Abstract
Background: Burn injuries are a leading cause of morbidity that can result in devastating disability and poor quality of life for survivors. This systematic review aimed to synthesise evidence regarding the effect of 20 minutes of cool running water (CRW) within three hours of injury on outcomes of patients with thermal burn injuries.

Methods: This systematic review was conducted in reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Multiple databases (PubMed, EMBASE, CENTRAL, CINAHL Complete via EBSCO, PROQUEST Dissertations and Theses), and the Australia New Zealand Clinical Trial Registry were searched for eligible studies published in English and Chinese, without date restriction. Meta-analyses were undertaken Methodological quality of studies was assessed by using Downs and Black Checklist.

Results: Of 323 records, seven studies were included. The majority (67%) of studies were conducted in Australia and New Zealand. The methodological quality was ranked between 'fair' and 'good'. Twenty minutes of CRW within the first three hours of burn injury significantly decreased the odds of patients requiring skin grafting and surgical intervention for wound management.

Conclusions: There is considerable evidence suggesting the application of 20 min of CRW within the first three hours of injury improves outcomes for patients with burn injury. Consensus between burn organisations and collaborative efforts to translate evidence into practice are needed to optimise burn first aid care which can improve patient outcomes globally.

Keywords: Burns; Cool running water; First aid; First responders; Thermal injury.

糖尿病藥物 Glyxamal 糖順平 Combination of empagliflozin and linagliptin improves blood pressure and vascular function in type 2 diabetes

2026-01-23
剛剛藥商來訪. 提供這篇 Glyxambi 研究報告給我參考

健保規定. 需使用最大耐受劑量 metformin 且並用 linagliptin(TRAJENTA 5mg 糖漸平)  或 Empagliflozin（Jardiance恩排糖）六個月以上

HbA1c > 7.5% 才可開立.

Glyxambi (糖順平25/5毫克)= trajenta 5mg + Jardiance 25mg 

Linagliptin=TRAJENTA 5mg 糖漸平 DPP4i

Empagliflozin=Jardiance 25mg/恩排糖 SGLT2i

Combination of empagliflozin and linagliptin improves blood pressure and vascular function in type 2 diabetes

Abstract
Aims: Preserved vascular function represents a key prognostic factor in type 2 diabetes mellitus (T2DM), but data on vascular parameters in this patient cohort are scarce. Patients with T2DM often need more than one drug to achieve optimal glucose control. The aim of this study was to analyse the efficacy of two combination therapies on vascular function in subjects with T2DM.

Methods and results: This prospective, randomized study included 97 subjects with T2DM. Subjects were randomized to either the combination therapy empagliflozin (E) 10 mg with linagliptin (L) 5 mg once daily or metformin (M) 850 or 1000 mg twice daily with insulin glargine (I) once daily. At baseline and after 12 weeks, subjects had peripheral office and 24-h ambulatory blood pressure (BP) measurement and underwent vascular assessment by pulse wave analysis under office and ambulatory conditions. Office, 24-h ambulatory and central BP as well as pulse pressure (PP) decreased after 12 weeks of treatment with E + L, whereas no change was observed in M + I. There were greater decreases in 24-h ambulatory peripheral systolic (between-group difference: -5.2 ± 1.5 mmHg, P = 0.004), diastolic BP (-1.9 ± 1.0 mmHg, P = 0.036), and PP (-3.3 ± 1.0 mmHg, P = 0.007) in E + L than M + I. Central office systolic BP (-5.56 ± 1.9 mmHg, P = 0.009), forward pressure height of the pulse wave (-2.0 ± 0.9 mmHg, P = 0.028), 24-h ambulatory central systolic (-3.6 ± 1.4 mmHg, P = 0.045), diastolic BP (-1.95 ± 1.1 mmHg, P = 0.041), and 24-h pulse wave velocity (-0.14 ± 0.05m/s, P = 0.043) were reduced to a greater extent with E + L.

Conclusion: Beyond the effects on glycaemic control, the combination therapy of E + L significantly improved central BP and vascular function compared with the classic combination of M + I.

Clinicaltrials.gov: NCT02752113.

野外與登山醫學-高海拔疾病 AMS. HACE. HAPE 發作時間

2026-01-23 00:44 AM

筆記-2025 CDC yellow book
CDC-High-Altitude Travel and Altitude Illness(CDC網站)
AMS症狀通常在抵達高海拔地區或攀登至更高海拔後 2-12 小時內出現
在相同海拔沒有繼續上升. AMS 通常會在 12-48 小時內消退。
Symptom onset is usually 2–12 hours after initial arrival at a high altitude or after ascent to a higher elevation and often during or after the first night. Preverbal children with AMS can develop loss of appetite, irritability, and pallor. AMS generally resolves within 12–48 hours if travelers do not ascend farther.
Symptoms starting after 3 days of arrival at high altitude and without further ascent should not be attributed to AMS

筆記 2023 High Altitude Pulmonary Edema(Archived)-Jacob D. Jensen
HAPE typically occurs 2 to 5 days after arrival at altitude.
2013NEJM
AMS 通常在上升到海拔2500公尺以上, 6-12小時之後發生。

(from uptodate)High-altitude pulmonary edema This topic last updated: Nov 19, 2025.

HAPE 高海拔肺水腫發生率 0.01-15% (在同樣海拔上升速率, 比 HACE 高). 通常在到達高海拔之後 2-4 天發作.
 Initial symptoms typically appear two to four days after arrival at a new altitude.

野外與登山醫學-Pulse Oximetry Is Useful in Predicting Acute Mountain Sickness 測量血氧濃度(Pulse Oximetry)預測是否會發生急性高山病(AMS)

2026-01-22 15:27

以血氧飽和度預測是否發生AMS
Pulse oximetry for the prediction of acute mountain sickness: A systematic review
(這段是我寫的)以前查詢血氧濃度與AMS相關性. 印象中罹患AMS和沒有生病的兩組. 血氧濃度交叉涵蓋的範圍不小. 有些血氧接近正常人平均值的也可能發生AMS. 有些低於正常人平均值的沒有發生AMS. 我的想法. 這些研究都是在特定條件下得出的結論. 結果可能受到很多因素影響, 例如基因差異. 當時高海拔地區的天氣. 路線難度及消耗體能的差異. 不同研究使用的儀器是否標準化(能直接將數據做比較). 還有很多其他可能會影響結果的因素. 得到的都只是特定條件下的研究結果. 未必能適用於所有地方.

在醫院實際使用夾手指的血氧機測定血氧飽和度時, 數值有時候會變動. 病患手指血流灌注是否正常. 夾的位置都會影響數據. 下面很多研究的血氧飽和度差異. 發生 AMS 與健康個體差異僅有 1%~4%. 說實在的. 我覺得差異不算大. (我覺得比較有臨床意義的大概是HAPE患者SpO2低於預期海拔10%)

研究納入和排除條件. 研究方法, 統計分析方式這些請到原文裡面查詢. 這裡僅截錄部分內容. 另外. 複製張貼原文的時候. SpO2 是特殊符號無法直接拷貝貼上. 內容很多地方少了SpO2 這個字. 翻譯起來會很怪. 若覺得翻譯怪的地方. 請回原文尋找答案

這篇研究報告的附錄有整理出所收納的七篇研究的主要結果. Main outcomes from included studies. 可以直接看原文

名詞翻譯
丹木斯=乙醯唑胺 acetazolamide
普拿疼=乙醯氨基酚(普拿疼是台灣比較為民眾熟知的止痛退燒商品)

重點整理
1. 海拔2400公尺至5300公尺處，進行中等強度日常運動（50公尺步行，目標心率150次/分）後的靜止血氧飽和度（R-SpO₂）和運動血氧飽和度（Ex-SpO₂）。可預測在海拔4300-5300公尺是否會發生AMS
2. 服用丹木斯可預防AMS，且可改善 SpO2(但並非 SpO2 低就需要吃丹木斯)

3. 在高海拔發生AMS的個體. 在較低海拔(2610-3402-3500-3647)的SpO低於健康組 (研究中所謂高低是比較出來的. 例如 3500 相較於 4300 是較低海拔. 但兩處都已經是高海拔地區)

4. 海拔3647公尺測得 SpO2 < 84% 有可能會發生AMS (86.67% sensitivity, 82.25% specificity)

INTRODUCTION 這段不翻譯請看原文
Acute mountain sickness (AMS) is one of three major high-altitude (HA, >2500 m) illnesses (including HA cerebral and pulmonary oedema; HACE and HAPE) (Imray et al., 2011) and can afflict as many as 75% of people who ascend to HA (Croughs et al., 2014; Karinen et al., 2008). AMS has a much higher incidence and occurs at much lower altitudes than the more severe syndromes of HACE and HAPE. HA illnesses are caused by exposure to the reduced atmospheric pressure and reduced partial pressure of oxygen relative to sea level, which ultimately creates a hypoxic state in exposed individuals.

急性高山病AMS與高海拔腦水腫都是因腦水腫引起. 腦水腫是因為血腦障壁BBB的通透性上升造成. 其機轉目前並不明確, 但推測是多種原因引起(有人推測各種原因,但也僅是推測). 缺氧,二氧化碳過高,血管壓力上升,發炎反應都與血管反應相關, 細胞毒性反應也有關聯, 無論如何, 腦水腫導致典型症狀出現，頭痛，噁心想吐，頭暈，疲憊倦怠，在極高海拔這些水腫反應可能嚴重到引起中樞神經異常，即是高海拔腦水腫HACE
AMS and HACE are caused by cerebral oedema due to increased fluid permeability of the blood–brain barrier. The mechanism for how this occurs is unclear but is thought to be multifactorial. Hypoxia, hypercapnia, increased vascular pressures and inflammatory processes have all been linked as vasogenic causes, with other cytotoxic causes also identified (Lafuente et al., 2016). Nevertheless, the cerebral oedema results in the classical collection of symptoms including HA headache, nausea/vomiting, dizziness and fatigue (Luks et al., 2017), and at extreme altitudes these oedematous changes can become profound enough to cause acute central neurological deficits. This is considered the threshold for the diagnosis of HACE.

預防AMS和HACE最好的方法是足夠的高海拔生理適應, 藉由休息間隔, 放慢爬升速率, 減少每天爬升海拔(在海拔超過3000公尺,每天上升不要超過500公尺)使身體能完成高度適應. 但要達到足夠的高度適應非常耗時間. 很難做到上述建議, 因此藥物預防被廣泛的使用,

這篇研究提到了參考oxford-handbook-of-expedition-and-wilderness-medicine 建議的上升速率. 這本書免費的PDF檔案可在網路搜尋到(第三版2023-08-24)  
The gold standard for both AMS and HACE prophylaxis is adequate physiological acclimatisation to HA, which can be achieved through rest periods, and slow and partial ascents (<500 m gain in sleeping altitude per day above 3000 m) (Imray et al., 2015). However, adequate acclimatisation is time consuming, prompting poor adherence and the widespread use of pharmaceuticals to aid the process.

丹木斯是最常使用的藥物, 丹木斯是碳酸酐酶抑制劑, 會引起酸血症. 酸血症會刺激呼吸中樞,增加呼吸驅動力,可提高氧氣輸送, 可加速高度適應, 因此，乙醯唑胺也可用於治療，儘管急性高山病（AMS）和高海拔腦水腫（HACE）在嚴重情況下均可透過吸氧和立即下降進行治療。 AMS 也可使用對普拿疼和充足的口服補液進行治療，而 HACE 則需要使用強效皮質類固醇（如地塞米松）治療以減輕腦水腫，這凸顯了預防和密切監測的重要性（Joyce 等，2018 年）。
Most noteworthy of these prophylactic aids is acetazolamide, a carbonic anhydrase inhibitor that induces mild acidaemia, which stimulates increased respiratory drive, and thereby increases oxygen delivery, thus accelerating acclimatisation (Leaf & Goldfarb, 2007). As such, acetazolamide can also be used for treatment, notwithstanding that both AMS and HACE can be treated with oxygen and immediate descent in severe cases. AMS can also be treated with paracetamol and adequate oral hydration, whereas HACE requires treatment with potent corticosteroids such as dexamethasone to reduce cerebral oedema, thus emphasising the importance of prevention and close monitoring (Joyce et al., 2018).

目前，AMS 的診斷仍以臨床表現為主(不需抽血或以其他儀器檢測)，當症狀嚴重時，診斷較為明確。儘管如此，在早期階段，AMS 可能難以界定，沒有明顯的跡像或症狀。自我報告的路易斯湖評分（LLS）標準也可用於評估 AMS，該標準涉及對頭痛、胃腸道不適、疲勞和頭暈/眩暈等症狀進行主觀排序（Roach 等，2018 年）。儘管LLS能夠追蹤疾病症狀的發展進程，並可作為輔助診斷手段，但目前它並不具備預測價值（Moore等人，2020）。 LLS的主觀性和可靠性爭議凸顯了採用更客觀、理想情況下更具前瞻性的方法來提高急性高山病（AMS）診斷準確性的必要性，這將使臨床醫生能夠及時識別高危險群並進行預防性干預。
Currently, diagnosis of AMS remains clinical, and when symptoms are severe, the condition makes diagnosis obvious. Despite this, in its earlier stages AMS can be ill-defined without distinctive signs or symptoms. The self-report Lake Louise Score (LLS) criteria can also be used to evaluate AMS, and involves subjectively ranking symptoms, such as headache, gastrointestinal distress, fatigue and dizziness/light-headedness (Roach et al., 2018). While the LLS is able to track progression of the illness as symptoms develop, and can be used as a diagnostic aid, it currently offers no predictive value (Moore et al., 2020). The subjectivity and disputed reliability of the LLS have emphasised the need for assessing AMS with improved diagnostic accuracy utilising more objective and ideally prospective methodology, which would allow clinicians to identify individuals who are at risk in time for preventative intervention.

研究人員已對生理參數進行了研究，以確定它們是否能夠作為更客觀的AMS預測手段，並評估其嚴重程度和易感性。鑑於AMS是長期暴露於低壓低氧環境的結果，動脈血氧飽和度一直是與AMS一同研究的常用生理參數。雖然直接測量動脈血氧飽和度SaO2（AOO）需要專門的設備和技術，這在研究環境之外幾乎不可能實現，但透過脈搏血氧儀測量週邊血氧飽和度（PBOS）則更為便捷，也更適合在高海拔地區進行實地應用。然而，關於脈搏血氧飽和度SpO2在評估急性高山病（AMS）嚴重程度的應用，現有文獻尚無定論（Major et al., 2012 ; O'Connor et al., 2004），而其在AMS預測的應用研究則較為匱乏。

Physiological parameters have been investigated to ascertain whether they can be used to form a more objective means of predicting AMS in individuals, as well as assessing severity and susceptibility. Given that AMS is the product of exposure to prolonged hypobaric hypoxia, arterial oxygenation has been the reflexive physiological parameter to investigate alongside AMS. Whilst direct measurement of arterial oxygenation () requires specialised equipment and techniques that are prohibitively impractical outside of research settings, measurement of peripheral blood oxygen saturation () via pulse oximetry is more convenient, and more practical for use in the field at altitude. Nevertheless, the literature surrounding the utility of in evaluating AMS severity appears inconclusive (Major et al., 2012; O'Connor et al., 2004), and the utility of in AMS prediction even less thoroughly researched.

本系統性回顧旨在評估高海拔地區脈搏血氧飽和度作為AMS易感性和嚴重程度預測指標的相關文獻，以便及早識別易患AMS的個體，對其進行更恰當的管理，並減輕疾病對個人、團隊和當地資源的負擔
The purpose of this systematic review is to evaluate the literature related to the use of pulse oximetry at high altitude as a predictive factor for AMS susceptibility and severity, so that individuals likely to develop the condition can be identified early, managed more appropriately, and disease burden on individuals, teams and local resources reduced.

2.2納入標準
本研究納入了以下人體研究：在健康低地居民攀登至陸地高海拔地區期間，透過脈搏血氧飽和度儀採集週邊血氧飽和度SpO2數據，並評估週邊血氧飽和度與急性高山病（AMS）嚴重程度之間的關係。排除以下研究：（1）研究對象包括動物、不健康的人類（例如，已知存在心臟/代謝/呼吸系統疾病、吸煙者）或僅包括高海拔居民（居住在海拔 2000 米以上）； (2) 使用模擬海拔（例如，在環境艙中進行常壓/低壓低氧）；(3) 未報告急性反應 (AMS) 評估方法 (AMS)；僅透過動脈血液樣本測量血氧飽和度；(5) 僅評估慢性高山病；(6) 僅在單一海拔或最高海拔 ≤2100 公尺處進行測量；或 (7) 未評估、分析或報告 AMS 嚴重程度或發生率與任何預測關係的結果。完整的納入與排除標準列於附錄A。涉及藥物/順勢療法介入的研究也被考慮，但僅當對照組/安慰劑組的數據能夠與治療組的數據區分開來，且在分析 AMS 的任何關係/差異時仍然相關時才予以納入。

2.2 Eligibility criteria
Human studies involving the collection of peripheral blood oxygen saturation (, via pulse oximetry) from healthy lowlanders during ascent to terrestrial high altitude that evaluated the relationship between and AMS severity were considered for eligibility. Studies were excluded that: (1) included animals, unhealthy humans (e.g., known pre-existing cardiac/metabolic/respiratory condition(s), smokers), or only highlanders (living above 2000 m); (2) utilised simulated altitude (e.g., normobaric/hypobaric hypoxia in an environmental chamber); (3) failed to report the AMS assessment method (e.g., LLS or Environmental Screening Questionnaire, ESQ); (4) measured blood oxygen saturation only by arterial samples; (5) assessed only chronic mountain sickness; (6) measured only at a single altitude or a maximum altitude ≤2100 m, or (7) failed to evaluate, analyse or report results for any predictive relationship between AMS severity or occurrence and . Full inclusion and exclusion criteria are listed in Appendix A. Studies involving pharmacological/homeopathic intervention(s) were considered, albeit only included if control/placebo group data could be isolated from those of the treated group(s) and were still relevant in the context of any relationship/difference in AMS.

2.6資料項
所需資料項包括：樣本量；使用的血氧飽和度監測設備；測量海拔/位置、解剖部位（例如，手指、耳垂）、頻率/間隔（例如，每秒一次；每5分鐘一次）和持續時間（例如，90秒）、時間（即，前瞻性測量、到達高原期測量、AMS發作時測量）、一天中的時間（例如，夜間、早晨或運動後測量）、環境溫度、人體狀態（即，清醒或睡眠狀態）和身體姿勢（例如，仰臥、坐姿、站立）。其他需要收集資料的變數包括：參與者特徵（例如，男性/女性、年齡）、上升速度（是否符合現有指南）、主要交通方式（例如，飛機、健行或汽車）、使用的急性高山病評估方法（例如，LLS、ESQ 或 AMS-C）、急性高山病的盛行率或發病率、應用於原始血氧飽和度資料的任何處理技術以及統計分析程序。

上升速度的評估依據《牛津探險與野外醫學手冊》中的上升指南，該指南規定，海拔3000米以上時，每日上升高度不應超過500米，且每3-4天休息一天。牛津探險與野外醫學手冊2023年第三版可在網路找到PDF檔案

2.6 Data items
Data items sought included: sample size; oximetry device used; measurement altitude/location, anatomical site (e.g., finger, earlobe), frequency/interval (e.g., every second; every 5 min) and duration (e.g., 90 s), timing (i.e., prospective, on arrival to altitude, at onset of sickness), time of day (e.g., overnight, morning, or post-exercise), ambient temperature, human state (i.e., awake or asleep), and body position (e.g., supine, seated, standing). Additional variables for which data were sought included: participant characteristics (e.g., male/female, age), rate of ascent (in line with existing guidelines, yes/no), predominant mode of transport (e.g., flight, trekking, or by car), AMS assessment method used (e.g., LLS or ESQ or AMS-C), prevalence or incidence of AMS, any processing techniques applied to raw oximetry data, and statistical analysis procedures. (Rate of ascent was assessed using the ascent guideline from the Oxford Handbook of Expedition and Wilderness Medicine, which stipulates that above 3000 m, ascent should be no more than 500 m per day with a rest day every 3–4 days.)

3 RESULTS結果

3.2.5 測量SpO2
大多數研究使用Nonin血氧儀在早晨進行指尖血氧飽和度測量（參見表2）。在納入的七項研究中，有五項研究在受試者靜坐休息時採集血氧飽和度數據，測量前受試者有最多15分鐘的休息時間以使生理狀態穩定（表3）。除了靜止狀態下的測量外，一些研究還考察了運動後（或運動過程中）的測量（Karinen 等，2010；Mandolesi 等，2014）。各研究的測量持續時間不一致，從連續測量到 1-2 分鐘不等（參見表2中的「測量持續時間」 ），而關於研究如何確定後續分析所用數值的細節則更加不一致，且往往不明確（參見表2中的「處理」 ）。
3.2.5 SpO2 measurements

Most studies measured SpO2 from the finger in the morning using Nonin oximeters (refer to Table 2). Five of the seven included studies collected oximetry measurements while participants were seated at rest, which was preceded by a period of rest (up to 15 min) to allow for physiological stabilisation (Table 3). In addition to resting SpO2 measurements, some studies also looked at post-exercise (or exercise)SpO2  (Karinen et al., 2010; Mandolesi et al., 2014). Measurement duration was inconsistent between studies, ranging from continuous to 1–2 min (refer to ‘Measurement duration’ in Table 2), with details surrounding how studies determined values to then be used in subsequent analysis being even less consistent, and often unclear (refer to ‘Processing’ in Table 2).

儘管存在這些差異，大多數研究都採取了一些措施來保證測量品質。除了允許生理穩定外，許多研究還概述了緩解策略，包括：讓參與者避風、戴手套並對結果不知情（Oliver 等，2012）；戴上連指手套（Karinen 等，2012）；在測量前數月內未前往海拔高於 2500 公尺的地區（即未適應高海拔）之前進行測量；測量在加熱帳篷內進行（Modesti 等，2011）。 

Despite observed differences, most studies took some action(s) to protect the quality of the measurements. In addition to allowing for physiological stabilisation, many studies outlined mitigation strategies, which included: participants being sheltered from the wind, wearing gloves and blinded to their results (Oliver et al., 2012); hands covered with mittens (Karinen et al., 2012); no travel to altitudes >2500 m in months prior (i.e., unacclimatised) (Karinen et al., 2010); measurements performed prior to any caffeine consumption (Cobb et al., 2021); and measurements performed in a heated tent (Modesti et al., 2011).

3.2.6 SpO2 and relationship with/prediction of AMS

不同研究之間. 預測AMS的方法各有差異. 因此得到不同結果. 

(... 以下這段省略中文翻譯)
3.2.6 SpO2 and relationship with/prediction of AMS 
Methods used to evaluate the prediction of AMS by SpO2 varied substantially between studies (as outlined in Table 4), producing multiform results (Appendix D), and thus precluding the possibility of carrying out traditional quantitative meta-analysis. As a result, qualitative meta-analysis was carried out. Some studies evaluated SpO2 as a standalone factor by means of correlation analysis, receiver operator characteristic and logistic regression (Mandolesi et al., 2014; Modesti et al., 2011), while other studies included SpO2 as part of multivariate prediction models (refer to Table 4). Studies often included multiple analyses.

其中兩項研究觀察到，在高海拔地區發生急性高山病AMS的個體，其在低海拔地區血氧飽和度SpO2 低於後來保持健康的個體（Cobb et al., 2021 ; Karinen et al., 2010）。

Two of the included studies observed that individuals who subsequently developed AMS at higher altitudes had a lower SpO2 at lower altitudes than their counterparts who later remained healthy (Cobb et al., 2021; Karinen et al., 2010). 

在海拔4300公尺及海拔4300-5300公尺出現高海拔疾病的個體. 海拔3500公尺靜止及運動SpO2低於健康組
4300公尺發生AMS. 海拔3500公尺靜止SpO2 88% VS 92%, 運動 SpO2 80% vs 85%
4300-5300公尺, 海拔3500公尺靜止SpO2 82% VS 86%, 運動 SpO2 76% vs 79%

Specifically, Karinen et al. (2010) observed this in both resting and exercise SpO2 in individuals at 3500 m who later became sick at 4300 m (88 ± 2% vs. 91 ± 3% , P < 0.05 and 80 ± 2% vs. 85 ± 4%, P < 0.01, respectively), and between 4300 m and 5300 m (82 ± 4% vs. 86 ± 5%, P < 0.01, 76 ± 4% vs. 79 ± 5%, P < 0.01).

Cobb and colleagues made similar observations, with individuals who became sick at any point having lower resting and post-exercise SpO2 at 3500 m (88.5% vs. 89.6%, P = 0.02 and 82.2% vs. 83.8%, P = 0.027)

 

 

 

Similarly, Mandolesi and colleagues observed that individuals who become sick with either mild or moderate-to-severe AMS were always more hypoxaemic at rest at altitudes as low as 3275 m (87.7 ± 3.5% vs. 86 ± 4.1% vs. 85.4% ± 4, P = 0.037, P = 0.030).

 

 不同海拔休息時的血氧濃度(2610公尺.3402公尺)與發生AMS相關

Further, Chen and colleagues observed the same relationship in resting SpO2 at every observation point in their study, even at 2610 m (93.1 ± 2.1% vs. 93.5 ± 2.3%; P = 0.023), and at 3402 m before and after summiting at 3952 m (86.2 ± 4.7% vs. 87.6 ± 4.3%; P < 0.001 and 85.5 ± 3.5% vs. 89.6 ± 3.2%; P < 0.001)

海拔2400公尺的血氧飽和度與AMS沒有顯著關聯. 但海拔3000-4300公尺運動後血氧飽和度較低的個體在海拔5000公尺以上出現症狀. 

Notably, Karinen and colleagues (2012) did not observe a significant relationship between resting SpO2 at 2400 m, but found exercise SpO2 to be lower at between 3000 and 4300 m in individuals who became sick above 5000 m (P < 0.05). (Specific data not provided by authors.)

Mandolesi及其同事推導出了一個臨界值$$在海拔3647公尺處，預測後續發生嚴重急性高山症（定義為LLS評分>5）的準確率為84%，其敏感性為86.67%，特異性為82.25%，受試者工作特徵曲線下面積（AUROC）為0.87（P<  0.0001）。

Mandolesi and colleagues derived a cutoff for of 84% at 3647 m for predicting later development of severe AMS (defined by LLS of >5), which demonstrated 86.67% sensitivity, 82.25% specificity, with area under the receiver operating characteristic curve (AUROC) = 0.87, P < 0.0001. 

當分析範圍限制在LLS評分≥6的嚴重AMS時，他們觀察到敏感性提高至90%，AUROC為0.91（P<  0.0001）。這個數值(84%)明顯低於Modesti及其同事得出的4200公尺SpO2臨界值91.5% (僅繪製了靈敏度和特異性曲線，未提供具體數值）。

When restricting analyses to severe AMS defined by LLS ≥ 6, they observed that the sensitivity improved to 90% and the AUROC was 0.91 (P < 0.0001). 

These cutoffs were noticeably lower than the 91.5% cutoff derived by Modesti and colleagues at 4200 m (sensitivity and specificity only plotted, no values provided). 

相較之下，Cobb及其同事並未發現靜止狀態下的$$SpO2 在海拔 3500 公尺處測得的指標（透過單變量迴歸分析）可作為徒步旅行期間嚴重高山症（LLS ≥ 5）的獨立預測因子；然而，基於其顯著性（即，P <  0.15 的變數被納入多重邏輯迴歸模型；優勢比 (OR) = 0.963 (95% CI: 0.850–）。儘管如此，Cobb 及其同事確實顯示運動後SpO2是嚴重 AMS 的重要獨立預測因子（OR = 0.870 (95% CI: 0.803–0.943)）；然而，並未評估單一變數的 AUROC。

By contrast, Cobb and colleagues did not identify resting measured at 3500 m to be a standalone predictor (by univariate regression) of severe AMS (LLS ≥ 5) during the trek; however, it was included in the subsequent multivariate regression model based on its significance (i.e., variables with P < 0.15 considered for inclusion in the multiple logistic regression model; odds ratio (OR) = 0.963 (95% CI: 0.880–1.055)). Nevertheless, Cobb and colleagues did show post-exercise to be a significant standalone predictor of severe AMS (OR = 0.870 (95% CI: 0.803–0.943)); however, the AUROC for individual variables was not evaluated.

3.2.7 其他與AMS預測相關的變數一些納入的研究揭示了其他生理參數與AMS後續發展之間的預測關係。例如，Karinen 及其同事（ 2012）的研究表明，心率變異性(heart rate variability)與AMS具有預測關係。

3.2.7 Other variables linked to AMS prediction
Some included studies revealed predictive relationships between other physiological parameters and subsequent development of AMS. For example, heart rate variability was shown to have a predictive relationship with AMS by Karinen and colleagues (2012). 

Mandolesi及其同事發現，靜止心率和在海拔3647公尺處過夜的心率與AMS之間有顯著相關性。同樣，Oliver及其同事也發現心率與AMS症狀評分呈正相關。相較之下，Karinen及其同事（2010）並未觀察到海拔3500公尺和4300公尺處的靜止心率與分別在海拔4300公尺和5300公尺處即將發生的AMS之間存在任何相關性。 

(海拔3500-4300公尺測得的心跳與之後在4300-5300公尺是否發生AMS無關)

Mandolesi and colleagues noted a significant relationship between heart rate (at rest and overnight at 3647 m) and AMS. Similarly, Oliver and colleagues showed a positive correlation between heart rate and AMS symptom score. By contrast, Karinen and colleagues (2010) did not observe any relationship between resting heart rate at 3500 m and 4300 m and impending AMS at 4300 and 5300 m, respectively.

Modesti及其同事也發現，年齡、性別、體重指數、血壓和呼吸頻率等其他因素與AMS（根據LLS定義）獨立相關。同樣，Modesti及其同事也發現，探險日期和氣壓等環境因素，以及凝血動力學、血球比容、肺動脈壓和兒茶酚胺血漿濃度等更複雜的因素，也是LLS在多變量模型中的獨立預測因子。
Modesti and colleagues identified several other factors such as age, sex, body mass index, blood pressure and respiratory rate that were independently associated with AMS (as defined by LLS). Similarly, Modesti and colleagues identified environmental factors including day of expedition and barometric pressure, as well as more complex factors such as coagulation dynamics, haematocrit, pulmonary artery pressure and catecholamine plasma concentration, which were also independent predictors of LLS within multivariate models.

3.2.8 高原藥物(預防性服用藥物的群體不納入統計)
本研究排除了納入服用增強高原適應藥物的受試者的研究。雖然可能存在部分受試者未申報服用乙醯唑胺等高原藥物，或服用處方藥導致數據出現反向混淆的情況，但考慮到納入研究的受試者總數，預計此類零星用藥的頻率不會對整體研究結果造成混淆。
3.2.8 Altitude drugs
Studies that included participants taking medications that enhance acclimatisation were excluded from this study. While it is possible some individuals did not declare use of altitude drugs such as acetazolamide, or were taking prescription medication that invertedly confounded the data, it is not anticipated that any such sporadic drug use occurred at a frequency that would confound the overall study findings, given the total number of individuals included.

4 討論
我們的系統性回顧表明，多項研究已證實靜止狀態降低與預測風險之間存在正面關係。$$SpO2測量結果顯示，海拔約 3500 至 4000 公尺的營地有發生高山症的風險。運動也呈現類似的趨勢。SpO2納入研究的幾項研究的作者也描述了測量方法和急性高山症（AMS）（Cobb et al., 2021 ; Karinen et al., 2010, 2012 ; Mandolesi et al., 2014）。然而，關於海拔剖面、方法、隊列和測量技術等方面的文獻存在著許多細微差別，這限制了我們得出明確結論的能力，如下所述。這也使得傳統的薈萃分析方法無法實施，因此需要對現有證據進行定性評估。雖然這可能引入了一定的偏倚，但不同方法策略下結果的一致性增強了研究結果的穩健性。
4 DISCUSSION
Our systematic review demonstrates that multiple studies have positively identified a predictive relationship between decreased resting SpO2 measured around 3500 to 4000 m and the risk of developing AMS at higher camps. A similar trend between exercising SpO2 measurements and AMS was also described by authors of several included studies (Cobb et al., 2021; Karinen et al., 2010, 2012; Mandolesi et al., 2014). There is, however, considerable nuance in the literature surrounding altitude profiles, methodologies, cohorts and measurement techniques, which limited our ability to draw definitive conclusions, as discussed below. This also prevented traditional meta-analytical techniques being carried out, and required a qualitative review of the evidence. Whilst this may have introduced an element of bias, findings consistent under the scrutiny of different methodological strategies adds an element of robustness to the findings.

未能證明$$SpO2對於上升速率超出現有建議範圍的急性高山症（AMS）患者而言，上升速率是一個重要的預測因子（參見圖 2c）（Modesti 等，2011）。這表明預測關係可能取決於上升速率。同樣，預測關係SpO2$$本次綜述中觀察到的急性高山症（AMS）（海拔最高可達6300公尺）可能僅在達到一定閾值之前有效，因為極端海拔（>5500公尺）的攀登路線需要更長時間的適應性訓練和分階段攀登。遺憾的是，本次綜述中所考察的所有預測模型均未能充分考慮攀登路線，而攀登路線被廣泛認為是導致急性高山症最重要的風險因素之一。因此，在將本研究結果外推至如此極端的海拔高度，或用於違反現有建議的攀登時，必須謹慎。
Ascents that failed to demonstrate SpO2 to be a significant predictive factor for AMS exhibited rates of ascent outside existing recommendations (refer to Figure 2c) (Modesti et al., 2011). This suggests that the predictive relationship may be dependent on rate of ascent. Similarly, the predictive relationship between SpO2 and AMS observed in this review (up to 6300 m) may only be relevant up to a threshold point, due to extreme altitude (>5500 m) ascent profiles necessitating extended acclimatisation and partial ascents over extended periods. Unfortunately, none of the predictive models examined in this review adequately addressed ascent profile, which is widely regarded as being one of the most significant risk factors for developing AMS. Thus, caution must be exercised when extrapolating the present findings to such extreme altitudes, or for ascents that go against current recommendations.

存在大量不一致之處SpO2$$測量方案是重要的限制因素。在高海拔地區，測量容易受到許多混雜因素的影響，包括紫外線指數和亮度增加、環境溫度升高以及寒冷引起的周圍血管收縮（Luks & Swenson，2011）。優化測量SpO2方法$$高海拔地區確實存在一些問題（Tannheimer & Lechner，2019），但在納入的七項研究中，有六項在發表時並未提供此類建議。儘管如此，作者們經常提及用於保護測量可靠性的策略（例如，為參與者遮風擋光或讓他們戴手套保暖手指），這表明作者們意識到各種可能影響測量結果的因素。$$SpO2閱讀材料。總而言之，這加強了與預測關係相關的研究結果$$Spo2以及 AMS。
There were substantial inconsistencies in SpO2 measurement protocols, which posed an important limiting factor. Measurements are susceptible to many confounding factors at altitude including increased UV index and brightness, ambient temperature, and peripheral vasoconstriction due to cold (Luks & Swenson, 2011). Methods for optimising the measurement ofSpO2  at high altitude do exist (Tannheimer & Lechner, 2019), but these recommendations were not available at the time of publication for six out of the seven included studies. Nevertheless, authors regularly cited strategies used to protect measurement reliability (e.g., sheltering participants from wind and light or having participants wear gloves to warm their fingers) suggesting that authors were aware of the variety of factors that have the potential to influence SpO2 readings. Together, this strengthened the findings related to the predictive relationship between SpO2 and AMS.

與其他研究相比，各項研究中對生理狀態的控制較為一致。$$SpO2測量技術本身。作者通常會概述一些程序，以確保在靜止測量前生理狀態穩定（例如，靜坐休息15分鐘）。然而，生理狀態（靜止狀態與運動狀態）以及測量前在高海拔地區停留的時間長短存在不一致之處。SpO2$$測量方法（到達時與隔天早晨）。這些變數需要充分控制，才能得出真正可靠的結論，例如，在預測高山症方面，哪種方法比另一種方法更有參考價值。
Control for physiological state was carried out with greater consistency across studies than SpO2 measurement techniques themselves. Authors often outlined procedures to ensure physiological stabilisation prior to resting measurements (e.g., 15 min of seated rest). However, there were inconsistencies in physiological state (rested vs. during exercise) and the duration of time spent at altitude prior to SpO2  measurements (arrival vs. morning after). These variables require adequate control to draw truly robust conclusions such as whether one was more informative than the other regarding prediction of AMS.

儘管研究結果積極，但其效用仍需進一步研究。SpO2單獨使用時，其預測能力被認為有限（Chen et al., 2012）。這很可能是由於存在大量重疊。SpO2常在組間（AMS組和非AMS組）觀察到。使用多元分析方法建立預測模型似乎增強了預測能力。SpO2（Cobb 等人，2021；Oliver等人，2012）。然而，遺憾的是，多元模型通常包含一些晦澀難懂且難以重複的變量，例如血細胞比容（Modesti等人，2011），這使得這些模型的外部驗證尤為困難。儘管如此，多元模型仍然有助於識別其他對急性高山症（AMS）具有預測價值的變量，特別是靜止心率和心率變異性。值得注意的是，並非所有與AMS相關的變數都能單獨預測AMS。這就引出了一個問題：這些生理參數是否可以與其他因素結合？SpO2旨在改進預測模型並創建臨床工具，以識別有急性高山症風險的登山者和健行者，或早期識別急性高山症。
Despite positive findings, the utility of SpO2 as a standalone predictor was described as limited (Chen et al., 2012). This is most likely due to the substantial overlap in SpO2 often observed between groups (AMS and non-AMS). The use of multivariate analysis methods for prediction models appeared to strengthen the predictive power of SpO2  (Cobb et al., 2021; Oliver et al., 2012). Unfortunately, however, multivariate models often included esoteric and difficult to replicate variables such as haematocrit (Modesti et al., 2011), which makes external validation of these models particularly challenging. Nevertheless, multivariate models helped identify other variables that had predictive utility for AMS, particularly that of resting heart rate and heart rate variability, although it is worth noting that not all of the variables identified as having relationships with AMS were found to be individual predictors of AMS. It raises the question as to whether such physiological parameters could be used in combination with SpO2 to improve predictive modelling and create clinical tools to identify climbers and trekkers at risk of developing AMS or early identification of AMS

最後，必須指出的是，評估AMS的方法各異（例如，LLS評分的臨界值不同，以及是否結合臨床因素）也會影響預測分析。本篇回顧納入的研究均在現行指引發布前開展，而現行指引並未包含LLS的睡眠成分（Roach等人，2018）。
Finally, it must be noted that the variable methods for assessing AMS (i.e., different LLS score cut-off, and used with and without clinical components) can also impact predictive analysis. Studies included in this review were conducted prior to publication of current guidelines, which omits the sleep component of the LLS (Roach et al., 2018).

4.1 未來方向
未來該領域的研究必須著重關注資料的品質和數量，理想情況下，應採用易於進行外部驗證和再驗證的變量，這是建模的核心原則。創建精確的機器學習工具是一個很有前景的選擇；然而，此類方法需要高品質且規模龐大的資料集，這在山區環境中可能很難取得。為了應對這些挑戰，未來的研究應致力於在多個野外研究中，使用高保真設備（例如，智慧型手機穿戴裝置）收集多種生理參數的數據，並保持符合現有建議的上升速度。同樣，未來的研究人員必須考慮多年來發表的不同LLS評分標準，並在進行任何跨研究的事後分析時將其納入考慮。將臨床評分添加到LLS總分中可能有助於提高預測準確性，並降低LLS的整體主觀性。
4.1 Future directions
Future research efforts in this area must focus on the quality and quantity of collected data, ideally with variables that enable easy external validation and re-validation, a core principle of modelling. The creation of accurate machine learning tools presents a promising option; however, such methods require high-quality datasets of substantial size, which can be challenging to obtain in the mountain environment. To combat these challenges, future studies should aim to collect data for multiple physiological parameters using high-fidelity devices (e.g., smartphone-enabled wearables) across multiple field studies with rates of ascent in line with existing recommendations. Similarly, future researchers must consider the different criteria for LLS published over the years, and must factor this in when conducting any post-hoc analyses across studies. The addition of the clinical score to the total sum LLS may improve predictions and limit the overall subjectivity of LLS.

4.2結論
總之，這項系統性回顧證實，兩者之間很可能存在預測關係。$$SpO2以及急性高山症（AMS）。研究還表明，這種效應並不顯著，不足以單獨用於臨床。可以透過回顧現有研究、對現有資料集進行事後分析或收集新資料來識別其他與急性高山症具有預測關係的生理參數。

4.2 Conclusions
In conclusion, this systematic review establishes that there is most likely a predictive relationship between and AMS. It also highlights that this effect is not profound enough to be of clinical use in isolation. Reviews of existing research, post-hoc analysis of existing data sets, or the collection of new data could be used to identify other physiological parameters that also share a predictive relationship with AMS.


Pro: Pulse Oximetry Is Useful in Predicting Acute Mountain Sickness
(下面中文使用google翻譯)
脈搏血氧儀是一種易於使用、非侵入性的工具，可用於評估高海拔地區人口的健康狀況。這些儀器提供動脈血氧飽和度的百分比估計值，這是動脈血氧分壓的函數。此百分比表示在任何時刻被氧氣佔據的血紅蛋白結合位點。在海平面，健康個體處於氧合血紅蛋白解離曲線的平坦部分；但在高海拔地區，隨著海拔升高，氧分壓降低，個體則處於曲線的陡峭部分（相比之下，這是一個「滑坡」），此時氧飽和度會隨著氧分壓的微小變化而發生顯著變化。

大多數健行和探險隊將脈搏血氧儀視為一種新奇物品，許多隊伍會攜帶價格低廉的袖珍脈搏血氧儀（有些僅售30美元），以便在登山過程中定期檢查血氧飽和度（SpO₂ ）。根據醫學文獻，脈搏血氧儀雖然並非百分之百準確，但對於預測AMS仍然很有用。

許多研究試圖探討低氧血症與AMS發生風險之間是否存在關聯。其中一些研究採用前瞻性設計，旨在確定行程早期氧飽和度下降是否會增加患有AMS的風險（Roach et al., 1998 ; Tannheimer et al., 2002 ; Karinen et al., 2010 ; Chen et al., 2012 ; Wagner et al., 2012 ; Chen et al., 2012 ; Wagner et al., 2012 ; Chen et al., 2012 ; Wagner et al., 2012 ;除上述兩項研究（Chen et al.和Wagner et al.）外，其他所有前瞻性觀察研究均發現二者有關聯。例如，Karinen et al.（2010）研究了八次探險中的83次攀登。在登山過程中，研究人員測量了海拔2400公尺至5300公尺處，受試者在進行中等強度日常運動（50公尺步行，目標心率150次/分）後的靜止血氧飽和度（R-SpO₂）和運動血氧飽和度（Ex-SpO₂）。他們採用路易斯湖評分（Roach ，1993 ）診斷AMS）。在探險過程中，所有海拔高度下，發生AMS的登山者的Ex-SpO₂均低於未 發生AMS的登山者。在海拔3500公尺和4300公尺處測得的R-SpO₂和Ex-SpO₂降低似乎 可以預測 在海拔4300公尺和5300公尺處即將發生AMS。

Chen等人（ 2012）和Wagner等人（2012 ）的研究為何與其他研究有所不同？一種解釋可能在於這些研究的方法。不同脈搏血氧儀的誤差範圍可能有差異。當需要檢測微小差異時，較大的誤差範圍可能不夠理想。其他導致結果差異的原因可能包括測試方法不同，以及對臨床意義的評估標準不同。

目前尚無針對低氧血症患者的隨機對照試驗（RCT）來確定，在發現患者血氧飽和度（SpO2）較低後立即給予AMS預防藥物，是否能預防 後續行程中的AMS。但先前在珠穆朗瑪峰地區進行的RCT，以乙醯唑胺與其他藥物或安慰劑相比，在預防AMS方面取得了顯著療效。這些研究一致表明，服用乙醯唑胺的受試者不僅能更有效地預防AMS，而且與藥物組或安慰劑組相比，其SpO2較基線水平也有顯著改善，儘管 實際改善幅度較小（Basnyat et al., 2003 ; Gertsch et al., 2004 ; Basnyat et al., 2011）。但這並不意味著建議使用脈搏血氧飽和度來決定哪些人應該服用乙醯唑胺。

一項重要的綜述（Burtscher等人， 2008）探討了透過測量動脈血氧飽和度來評估模擬低氧暴露對AMS易感性的影響。該綜述回顧了16項研究，這些研究在受試者 暴露於相當於海拔2300至4200米的模擬低氧環境20至30分鐘後測量了動脈血氧飽和度（SaO₂ ） 。結果顯示，這些飽和度值能夠正確預測超過80%的AMS易感性病例。近期另一項研究（Faulhaber等人， 2014 年）表明，在模擬低氧暴露30分鐘後，除了測量血氧飽和度外，額外測定呼吸頻率可以提高AMS預測的準確性。此外，還有一項有趣的研究（Tannheimer等人， 2009 年）發現，在白朗峰（海拔4808公尺）完成跑步任務所需的時間以及完成該任務時的最低血氧飽和度可以預測個體在進一步攀登過程中發生AMS的風險。因此，除了在高海拔地區測量血氧飽和度（ SpO2 ）外，其他易於測量的參數（例如呼吸頻率、運動時間）可能有助於提高SpO2 讀數在預測AMS方面的準確性。一項近期開展的、引人入勝且全面的研究（Richalet等人， 2012）納入了1326名受試者，結果表明，在前往海拔4000米以上地區之前，低氧環境下運動時氧飽和度下降22%或以上是導致嚴重高原反應的獨立危險因素。該研究並未探討對較輕微的AMS的易感性，且該研究存在方法學缺陷，即超過三分之二的受試者未能完成研究。

事實上，有大量醫學文獻支持使用脈搏血氧飽和度監測儀，根據基線讀數預測AMS。 AMS與SpO₂降低之間聯繫的至少一個可能的病理生理學解釋是通氣不足。如果過度通氣是適應高原環境的基石，那麼AMS患者可能出現通氣不足，從而導致SpO₂降低（ Basnyat和Murdoch， 2003）。另一個病理生理機制可能是亞臨床肺水腫(很輕微尚未出現症狀的肺水腫)，正如Ge及其同事（1997）所展示的那樣，他們測量了32名受試者在海拔2260米處以及上升至4700米後的肺一氧化碳彌散量（DLCO）。在非AMS受試者中，DLCO隨海拔升高而增加，而在AMS患者中，DLCO並未顯著增加。然而，當Dehnert等人… （2010 年）試圖在海拔高達 4559 公尺的個體中重現這一發現，但他們未能重現這些結果。

脈搏血氧儀甚至被用於預測登頂成功率（Tannheimer等人， 2002）。但顯然，脈搏血氧儀讀數存在潛在的缺陷；例如，需要考慮個體差異、海拔高度的閾值以及SpO2的較大標準偏差（ Luks和Swenson， 2011 ； Windsor， 2012；Zafren， 2012）。

鑑於脈搏血氧儀的普及程度，無論我們今天對AMS的立場如何，登山者仍會繼續使用它來預測AMS。因此，進行更多關於此主題的研究（包括特定脈搏血氧儀的準確性及其誤差範圍、統一的測量方法以及避免數據誤讀）以「完善」這門科學至關重要。

Pulse oximeters are easy to use, noninvasive tools for the assessment of individuals at high altitude. These instruments provide an estimate in percentage of arterial hemoglobin oxygen saturation, which is a function of arterial partial pressure of oxygen. The percentage denotes the hemoglobin binding sites that are occupied at any one time by oxygen. At sea level, healthy individuals will be on the flat portion of the oxyhemoglobin dissociation curve, but at high altitude as the partial pressure of oxygen decreases with ascent, individuals will be at the steep portion of the curve (a slippery slope by comparison) where saturation changes significantly with respect to small changes in the partial pressure.

Most trekking and expedition groups use pulse oximeters as a novelty item, and many groups carry an inexpensive, pocket pulse oximeter (some as little as US $30) to periodically check the oxygen saturation (Spo2) as they as ascend up the trail. Based on medical literature, the pulse oximetery, though not 100% accurate, is useful in predicting acute mountain sickness (AMS).

Many studies have attempted to see if there is a link between hypoxemia and the likelihood of developing AMS. Some of these studies have used a prospective design to determine if decreased oxygen saturation earlier in the trip have increased the likelihood of suffering from AMS (Roach et al., 1998; Tannheimer et al., 2002; Karinen et al., 2010; Chen et al., 2012; Wagner et al., 2012; Faulhaber et al., 2014). Except for two studies above (Chen et al. and Wagner et al.), all the other studies in these prospective observations found a link. For example, Karinen et al. (2010) studied 83 ascents during eight expeditions. They measured both resting Spo2 (R-Spo2) and exercise Spo2 (Ex-Spo2) after moderate daily exercise [50 m walking, target heart rate 150 bpm] at altitudes of 2400 to 5300 m during ascent. The Lake Louise Score (Roach, 1993) was used in the diagnosis of AMS. Ex-Spo2 was lower at all altitudes among those climbers suffering from AMS during the expeditions than among those climbers who did not get AMS at any altitude during the expeditions. Reduced R-Spo2 and Ex-Spo2 measured at altitudes of 3500 and 4300 m seem to predict impending AMS at altitudes of 4300 m and 5300 m.

Why were the studies by Chen et al. (2012) and Wagner et al. (2012) different from the rest? One explanation may lie in the methodology of these studies. Error ranges in various pulse oximeters may be different. Large error ranges may not be good enough when small differences are being looked for. Other reasons for the differing results may be test performance methods, and possibly differences in assessment of clinical significance.

There are no randomized controlled trials (RCTs) of hypoxemic individuals to determine if starting them on AMS prophylaxis after they are identified as having a low Spo2 prevents AMS later in the trip. But RCTs using acetazolamide vs. other drugs or placebo in the prevention of AMS in the Everest region have consistently shown that those participants on acetazolamide were not only significantly more protected from AMS, but also had significant increased changes in their Spo2 compared to the drug or placebo group from the baseline, even though the actual changes were small (Basnyat et al., 2003; Gertsch et al., 2004; Basnyat et al., 2011). This is not to advocate using pulse oximetry to determine who should take acetazolamide.

An important review (Burtscher et al., 2008) of exposure to simulated hypoxia with measurement of arterial oxygen saturation to determine AMS susceptibility has also been carried out. Sixteen studies were reviewed where Sao2 was measured 20 to 30 min after exposure to simulated hypoxia equivalent to 2300 to 4200 m. The saturation values correctly predicted AMS susceptibility >80% of cases. Recently another study (Faulhaber et al., 2014) revealed that the additional determination of breathing frequency to oxygen saturation reading after 30 min exposure to simulated hypoxia can improve success in AMS prediction. Yet another interesting study (Tannheimer et al., 2009) revealed that the time necessary to complete a running task at high altitude on Mont Blanc (4808 m) and the lowest oxygen saturation while performing this task was predictive of an individual's risk of developing altitude sickness with further ascent. Hence other easily measurable parameters (such as respiratory rate, exercise time) in addition to measurement of Spo2 at high altitude may help improve the accuracy of the Spo2 readings vis a vis prediction of AMS. A fascinating, comprehensive recent study (Richalet et al., 2012) of 1326 subjects revealed that oxygen desaturation equal to or greater than 22% at exercise in hypoxia before a sojourn to >4000 m was an independent risk factor for predisposing a person to severe altitude sickness. The study did not address predisposition to the more benign form of the disease (i.e., AMS) and the study also had a methodological flaw in that more than two-thirds of the subjects did not complete the study.

Indeed, there is no dearth of medical literature supporting the use of pulse oximetry to predict AMS at a higher altitude from a baseline reading. At least one possible pathophysiological rationale for the link between AMS and decreased Spo2 may be adequate ventilation. If hyperventilation is the cornerstone of acclimatization, AMS patients may have hypoventilation with resultant decreased Spo2 (Basnyat and Murdoch, 2003). Another pathophysiological mechanism may be subclinical pulmonary edema as shown by Ge and colleagues (1997) who measured pulmonary diffusion capacity for carbon monoxide (DLCO) in a group of 32 subjects at 2260 m and following ascent to 4700 m. In subjects without AMS, the DLCO increased at higher altitude while in AMS patients the DLCO did not increase significantly. However when Dehnert et al. (2010) tried to reproduce this finding in individuals sojourning up to 4559 m, they were unable to replicate these results.

Pulse oximeters are even being used to predict summit success(Tannheimer et al., 2002). But clearly there are potential pitfalls of pulse oximeter readings; for example, individual variations, cut- offs for altitudes, and large standard deviations of the Spo2 need to be taken into account (Luks and Swenson, 2011; Windsor, 2012; Zafren, 2012).

Given the popularity of pulse oximeters, mountain sojourners will continue to use them to try to predict AMS, regardless of where we stand on this issue today. It is therefore very important to do further studies on this topic (including accuracy of particular pulse oximeters and their error ranges, uniform measurement methods, and avoiding misinterpretation of data) to “refine” this science.