路易斯湖在位於加拿大落基山脈的班夫國家公園內. 湖面海拔約 1750 公尺.
症狀 symptoms 是病患覺得自己有哪些不尋常的症狀. 是病患自己說的. 但嬰幼兒或年長者或其他無法清晰明確表達群體. 也可由照護者代為表達病患症狀. 例如全身虛弱. 例如食慾不振.
徵象 signs 是指身體檢查發現的特定發現. 例如生命體徵(vital signs)體溫.心跳.血壓.氧氣濃度.
要描述紀錄患者的狀況. 除了 symptoms /signs, 還有一些屬於實驗室檢查. 包括抽血,驗尿. 糞便檢查. 各種疾病快篩. 影像學檢查(x光.超音波.電腦斷層. 核磁共振. 心電圖. 肌電圖. 腦波等等等)
統一名詞翻譯
Dexamethasone 類固醇(地塞米松), 高海拔疾病的研究或文獻. 提到的類固醇幾乎都是指 dexamethasone(類固醇種類很多,不僅地塞米松一種)
HAI= high altitude illness 高海拔疾病(等於高山症)
AMS =acute mountain sickness 急性高山病(不等於高山症)
HAC=E high altitude cerebral edema 高海拔腦水腫
HAPE =high altitude pulmonary edema 高海拔肺水腫
Acetazolamide 丹木斯(乙酰唑胺). 一種利尿劑
Nifedipine 硝苯地平, 是一種降血壓藥物, 分類上屬於鈣離子阻斷劑CCB, 於1969年被合成，1981年在美國核准上市。
The lake louise consensus on the quantification of altitude illness
January 1992-PDF檔案下載處
1991年這次共識會提出HAPE診斷需要有兩個以上的症狀及兩個以上的徵象,
在1991年國際低氧症研討會上，與會者達成共識，對各種高原疾病進行量化。這個過程分為幾個階段，由 Peter Hackett(彼得·哈克特)和Oswald Oelz(奧斯瓦爾德·厄爾茨)主持。
在會議召開前，共識委員會收到了有關高山症定義和量化方法的文件。會議期間，所有代表都有機會參與文件的編寫工作。委員會在會議期間多次召開會議，最後制定了這份共識文件。
本文件反映了截至1991年3月的發展現狀，其內容包括：
a) 高海拔症候群的診斷標準，
b) 對高海拔疾病的各種症狀/徵象進行評分的既定流程。
c) 自我評估問卷，
d) 臨床評估－由觀察者進行
建議在接下來的兩年內，由那些對高原疾病進行實地研究的研究人員使用上述方案，並在 1993 年 2 月 9 日至 13 日於路易斯湖舉行的 1993 年國際缺氧研討會上討論結果
以下診斷標準已被接受。
AMS 急性高山病
在近期海拔升高的情況下，出現頭痛，並伴隨以下至少一種症狀：胃腸道症狀（厭食、噁心或嘔吐）、疲勞或虛弱、頭暈或頭暈、睡眠困難。
HACE
可視為「末期」或重度AMS(急性高山病)。在近期海拔升高的情況下，如果急性高山症患者出現精神狀態改變和/或共濟失調，或非急性高山症患者同時出現精神狀態改變和共濟失調，則應考慮此診斷。
HAPE
在近期海拔升高的情況下，有以下情況：
以下症狀至少出現兩項(症狀是病人自己說的)
靜止時呼吸困難、咳嗽、虛弱或運動能力下降、胸悶或胸悶。
以下徵象至少出現兩項(徵象=身體檢查)
至少有一個肺野出現囉音或喘鳴音、中心性紫紺、呼吸急促、心跳過速。
Campbell 博士評論道：
雖然這並非我的專業領域，但我必須表達一些擔憂，目前提出的所謂分類並非異源性分類。急性高山病（AMS）的定義是基於症狀或綜合徵，而高海拔腦水腫（HACE）的定義則是基於病理生理學。 AMS 的基本病理生理機轉很可能與 HACE 類似。另一方面，HACE 的病理生理機轉也可能導致類似 AMS 的症候群。任何分類（而非簡單的清單）都應盡可能做到同源性分類。
待辦事項：
1）解決 Moran Campbell 對 HACE 定義不明確的擔憂。
2）Bartsch 建議將呼吸急促和心動過速進行量化。
At the 1991 International Hypoxia Symposium, a consensus process to quantify the various altitude maladies occurred. There were several stages in the process which was chaired by Peter Hackett and Oswald Oelz.
Prior to the conference, a consensus committee was given documents pertaining to definitions and ways to quantify altitude illness. At the conference, all delegates were given the opportunity to have input into the preparation of the document. The committee met on several occasions during the meeting and developed this consensus document.
This document represents the present state of its evolution, as of March, 1991. It consists of:
a) diagnostic criteria of altitude syndromes,
b) an agreed process of scoring the various symptoms/signs of altitude illness.
c) self assessment questionnaires,
d) clinical assessment-performed by an observer
It is proposed that the above schema be used over the next two years by those investigators conducting field research into altitude illness and the outcome discussed at the 1993 International Hypoxia Symposium at Lake Louise, February 9-13, 1993.
The following DIAGNOSTIC CRITERIA were accepted.
AMS
In the setting of a recent gain in altitude, the presence of headache and at least one of the following symptoms: gastrointestinal (anorexia, nausea or vomiting), fatigue or weakness, dizziness or lightheadedness, difficulty sleeping.
HACE
Can be considered "end stage" or severe AMS. In the setting of a recent gain in altitude, the presence of a change in mental status and/or ataxia in a person with AMS, or the presence of both mental status change and ataxia in a person without AMS.
HAPE
In the setting of a recent gain in altitude, the presence of the following:
Symptoms: at least two of:
dyspnea at rest, cough, weakness or decreased exercise performance, chest tightness or congestion.
Signs: at least two of:
rales or wheezing in at least one lung field, central cyanosis, tachypnea, tachycardia.
Comment from Dr. E.J.M. Campbell:
Although this is not my field, I must express some concern that the so-called classification put forward is not heterologous. AMS is defined in symptomatic or syndromal terms whereas HACE is defined in pathophysiological terms. It may well be that AMS has as its basic pathophysiology something not unlike HACE. On the other hand, it may well be that the pathophysiology ofHACE can cause a syndrome like AMS. It is much preferable that any classification (as opposed to simply a list) should be isologous. To be done: 1) Address Moran Campbell's concern about unclear definition of HACE. 2. Bartsch suggests that tachypnea and tachycardia should be quantified.
At the 1991 International Hypoxia Symposium, a consensus process to quantify the various altitude maladies occurred. There were several stages in the process which was chaired by Peter Hackett and Oswald Oelz.
Prior to the conference, a consensus committee was given documents pertaining to definitions and ways to quantify altitude illness. At the conference, all delegates were given the opportunity to have input into the preparation of the document. The committee met on several occasions during the meeting and developed this consensus document.
This document represents the present state of its evolution, as of March, 1991. It consists of:
a) diagnostic criteria of altitude syndromes,
b) an agreed process of scoring the various symptoms/signs of altitude illness.
c) self assessment questionnaires,
d) clinical assessment-performed by an observer
It is proposed that the above schema be used over the next two years by those investigators conducting field research into altitude illness and the outcome discussed at the 1993 International Hypoxia Symposium at Lake Louise, February 9-13, 1993.
The following DIAGNOSTIC CRITERIA were accepted.
AMS
In the setting of a recent gain in altitude, the presence of headache and at least one of the following symptoms: gastrointestinal (anorexia, nausea or vomiting), fatigue or weakness, dizziness or lightheadedness, difficulty sleeping.
HACE
Can be considered "end stage" or severe AMS. In the setting of a recent gain in altitude, the presence of a change in mental status and/or ataxia in a person with AMS, or the presence of both mental status change and ataxia in a person without AMS.
HAPE
In the setting of a recent gain in altitude, the presence of the following:
Symptoms: at least two of:
dyspnea at rest, cough, weakness or decreased exercise performance, chest tightness or congestion.
Signs: at least two of:
rales or wheezing in at least one lung field, central cyanosis, tachypnea, tachycardia.
Comment from Dr. E.J.M. Campbell:
Although this is not my field, I must express some concern that the so-called classification put forward is not heterologous. AMS is defined in symptomatic or syndromal terms whereas HACE is defined in pathophysiological terms. It may well be that AMS has as its basic pathophysiology something not unlike HACE. On the other hand, it may well be that the pathophysiology ofHACE can cause a syndrome like AMS. It is much preferable that any classification (as opposed to simply a list) should be isologous. To be done: 1) Address Moran Campbell's concern about unclear definition of HACE. 2. Bartsch suggests that tachypnea and tachycardia should be quantified.
沒有留言:
張貼留言