B型肝炎表面抗原

B肝帶原者, 如果測不到B肝表面抗原, 稱為B肝表面抗原「陰轉」, 但病患仍為帶原者
仍須持續追蹤
.
B肝表面抗原「陰轉」（HBsAg seroconversion），表面抗原消失，表面抗體（Anti-HBs）由陰轉陽。

仍然是B肝帶原者，抽血檢測B肝病毒DNA（HBV DNA） 很可能仍呈陽性, 仍應定期長期追蹤。

即使血中已測不到HBV DNA，若罹患淋巴癌或自體免疫疾病而接受類固醇或免疫抑制治療時，可能會激活肝細胞核內的B肝病毒cccDNA(covalently closed circular DNA))再度大量複製，B肝病毒表面抗原（HBsAg）會再度呈現陽性反應，病毒顆粒也會再度出現。

極少數潛在的B肝帶原者過去從未驗過B肝病毒標記，首次檢驗即呈現此等結果

野外與登山醫學---0--WMS 2019 acute altitude illness update 目錄

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2019 Update

統一名詞翻譯

AMS 急性高山病 (不建議使用高山症, 症通常是指不同病因但有相似症狀的疾病)
舉例: 類流感症候群, 發燒合併其他呼吸道症狀, 類流感症狀的原因很多, 例如登革熱, 鉤端螺旋體感染, 虐疾等等)
(流感之外的其他疾病,呼吸道症狀並非典型症狀)
(流感患者也可能沒有呼吸道症狀)
HACE 高海拔腦水腫
HAPE 高海拔肺水腫

 

Acute altitude illness (AAI) 急性高海拔疾病/高山症
(民眾常將急性高山病AMS與 acute altitude illness 高山症/高海拔疾病搞錯)

AAI (acute altitude illness) 包含AMS, HACE, 及 HAPE

 
acetazolamide 丹木斯
Dexamethasone 類固醇(地塞米松, 類固醇種類繁多,為了方便閱讀, 以類固醇代替)
Inhaled budesonide 吸入性類固醇(吸入性類固醇不僅這一種)
Staged ascent 分段爬升
Preacclimatization 高度適應
Hypoxic tents 低氧帳

高海拔定義,何時可使用本指引

Acute mountain sickness and high altitude cerebral edema
PREVENTION
Gradual ascent 建議緩慢爬升睡眠海拔高度, 以預防AMS/HACE
Acetazolamide 中度或高度風險時,強烈建議使用丹木斯預防AMS/HACE, 兒童也可以使用
Dexamethasone 中度或高度罹患AMS風險等級, 建議作為丹木斯替代藥物, 兒童不建議使用
Inhaled budesonide 吸入性類固醇不建議做為預防AMS藥物
Ginkgo biloba 不建議使用銀杏預防AMS(或其他高海拔疾病)
Ibuprofen 不想或不能吃丹木斯/類固醇的人, 可服用布洛芬預防AMS. 證據等級 2B
Acetaminophen 不建議使用普拿疼替代丹木斯或類固醇, 做為預防AMS藥物
Staged ascent and preacclimatization
Hypoxic tents
Other options

AMS/HACE/HAPE 發生率(急性高山病/高海拔腦水腫/高海拔肺水腫)

https://ymmcc2019.blogspot.com/2023/08/amshacehape.html

201711080910 AMS HAPE HACE 海拔 3600 西藏機場調查高海拔疾病發生率

https://ymmcc2019.blogspot.com/2019/12/3600-ams-hape-hace.html

野外及登山醫學---WMS 2019 acute altitude illness update 目錄

https://ymmcc2019.blogspot.com/2020/04/wms-2019-acute-altitude-illness-update_28.html

HAPE + HACE TREATMENT APPROACH 39

https://www.blogger.com/blog/post/edit/preview/1858837996889081076/3409425706749151133

野外及登山醫學---Acute altitude illness WMS 2019 update HAPE TREATMENT SUGGESTED APPROACH 38

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_21.html

野外及登山醫學---Acute altitude illness WMS 2019 update HAPE TREATMENT Diuretics/Acetazolamide 36

https://www.blogger.com/blog/post/edit/preview/1858837996889081076/8596568490877058325

野外及登山醫學---Acute altitude illness WMS 2019 update HAPE TREATMENT Dexamethasone 37

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_88.html

野外及登山醫學---Acute altitude illness WMS 2019 update HAPE TREATMENT Continuous positive airway pressure 35

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_72.html

野外及登山醫學---Acute altitude illness WMS 2019 update HAPE TREATMENT Phosphodiesterase inhibitors 34

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_60.html

野外及登山醫學---Acute altitude illness WMS 2019 update HAPE TREATMENT Nifedipine 32

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_87.html

野外及登山醫學---Acute altitude illness WMS 2019 update HAPE TREATMENT Beta-agonists 33

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_69.html

野外及登山醫學---Acute altitude illness WMS 2019 update HAPE TREATMENT Portable hyperbaric chambers 30

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_70.html

野外及登山醫學---Acute altitude illness WMS 2019 update HAPE TREATMENT Supplemental oxygen 29

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_29.html

野外及登山醫學---Acute altitude illness WMS 2019 update HAPE TREATMENT Descent 28

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_54.html

野外及登山醫學---27--WMS 2019 update HAPE PREVENTION SUGGESTED APPROACH

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-ilness-wms-2019-update_19.html

野外及登山醫學---Acute altitude illness WMS 2019 update HAPE PREVENTION Preacclimatization and staged ascent 26

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_83.html

野外及登山醫學---Acute altitude illness WMS 2019 update HAPE PREVENTION Acetazolamide 25

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_42.html

野外及登山醫學---Acute altitude illness WMS 2019 update HAPE PREVENTION Dexamethasone 24

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_3.html

野外及登山醫學---Acute altitude illness WMS 2019 update HAPE PREVENTION Tadalafil 23

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_55.html

野外及登山醫學---Acute altitude illness WMS 2019 update HAPE PREVENTION Salmeterol 22

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_1.html

野外及登山醫學---Acute altitude illness WMS 2019 update HAPE PREVENTION Nifedipine 21

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_14.html

野外及登山醫學---20--WMS 2019 update HAPE PREVENTION Gradual ascent

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_25.html

野外及登山醫學---Acute altitude illness WMS 2019 update AMS/HACE Treatment SUGGESTED APPROACH 19

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_76.html

野外及登山醫學---Acute altitude illness WMS 2019 update AMS/HACE Treatment Acetaminophen/ Ibuprofen 17

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_15.html

野外及登山醫學---Acute altitude illness WMS 2019 update AMS/HACE Treatment Continuous positive airway pressure 18

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_63.html

野外及登山醫學---Acute altitude illness WMS 2019 update AMS/HACE Treatment Acetazolamide 15

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_4.html

野外及登山醫學---Acute altitude illness WMS 2019 update AMS/HACE Treatment Dexamethasone 16

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Tre

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_7.html

野外及登山醫學---Acute altitude illness WMS 2019 update AMS/HACE Treatment Portable hyperbaric chambers 14

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_32.html

野外及登山醫學---Acute altitude illness WMS 2019 update AMS/HACE Treatment Supplemental oxygen 13

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_73.html

野外及登山醫學---Acute altitude illness WMS 2019 update AMS/HACE Treatment Descent 12

Wilderness Medical Society Clinical Practice Guidelines for the Pr

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_0.html

野外及登山醫學---Acute altitude illness WMS 2019 update AMS/HACE prevention suggested approach 11

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_13.html

野外及登山醫學---Acute altitude illness WMS 2019 update AMS/HACE prevention others 10

https://ymmcc2019.blogspot.com/2020/04/acute-altitude-illness-wms-2019-update_96.html

WMS 2019 update -- Conclusions  40(最後一篇了)  (done)

下面是導向隨意窩 xuite 連結. 已經失效. 多數有轉貼到這個blogger

Acute mountain sickness and high altitude cerebral edema
PREVENTION
Gradual ascent 建議緩慢爬升睡眠海拔高度, 以預防AMS/HACE
Acetazolamide 中度或高度風險時,強烈建議使用丹木斯預防AMS/HACE, 兒童也可以使用
Dexamethasone 中度或高度罹患AMS風險等級, 建議作為丹木斯替代藥物, 兒童不建議使用
Inhaled budesonide 吸入性類固醇不建議做為預防AMS藥物
Ginkgo biloba 不建議使用銀杏預防AMS(或其他高海拔疾病)
Ibuprofen 不想或不能吃丹木斯/類固醇的人, 可服用布洛芬預防AMS. 證據等級 2B
Acetaminophen 不建議使用普拿疼替代丹木斯或類固醇, 做為預防AMS藥物
Staged ascent and preacclimatization
Hypoxic tents
Other options

SUGGESTED APPROACH TO AMS/HACE PREVENTION 總結AMS/HACE預防策略


Conclusion 結論

野外與登山醫學--40-- WMS 2019 update -- Conclusions 40(最後一篇了) (done)

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2019 Update
中文翻譯目錄

統一名詞翻譯
AMS 急性高山病
HACE 高海拔腦水腫
HAPE 高海拔肺水腫
acute altitude illness 急性高海拔疾病

Conclusions

這篇文章提供了以實證為基礎的高海拔疾病指引. 包括AMS, HACE, HAPE 預防及治療方式. 以及各種方法的在疾病中扮演的角色, 仍有很多重要的問題, 需要更多未來的研究., 包括避免高海拔疾病的最適當上升速率, 丹木斯對於預防及治療HAPE的角色, 預防及治療兒童高海拔疾病的最適當藥物劑量, 階段性上升的角色. 高度適應, 使用低氧帳篷預防高海拔疾病. 

We have provided evidence-based guidelines for prevention and treatment of acute altitude illnesses, including the main prophylactic and therapeutic modalities for AMS, HACE, and HAPE, and recommendations regarding their role in disease management. Although these guidelines cover many of the important issues related to prevention and treatment of altitude illness, several important questions remain to be addressed and should serve as a focus for future research. Such research includes determining the optimal rate of ascent to prevent altitude illness, the role of acetazolamide in HAPE prevention and treatment, proper dosing regimens for prevention and treatment of altitude illness in the pediatric population, and the role of staged ascent, preacclimatization, and hypoxic tents in altitude illness prevention.

野外與登山醫學---39--WMS 2019 update HAPE + HACE TREATMENT APPROACH 39

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2019 Update

中文翻譯目錄

統一名詞翻譯
AMS 急性高山病
HACE 高海拔腦水腫
HAPE 高海拔肺水腫
acute altitude illness 急性高海拔疾病

同時罹患高海拔肺水腫 HACE 與高海拔腦水腫 HAPE 的建議處置
SUGGESTED APPROACH FOR PATIENTS WITH CONCURRENT HAPE AND HACE

應使用類固醇, 劑量與 HACE 治療相同
有些罹患 HAPE 的病患可能會因為缺氧性腦病患而出現神經功能異常, 而非由 HACE 引起, 但在野外環境無法將缺氧的腦病變與 HACE 區隔, 因此 HAPE 患者若出現神經功能異常, 給予氧氣治療後, 如果血氧飽和度改善, 但症狀沒有迅速改善, 應使用類固醇
如果無法提供氧氣, 對於HAPE患者若出現神智改變,或懷疑有高海拔腦水腫, 應給予類固醇
同時罹患 HAPE 與 HACE 的患者可以服用鈣離子阻斷劑 Nifedipine 或其他肺血管擴張劑, 但要小心不要讓平均動脈壓降太低, 平均動脈壓降低可能減少腦部血流灌注. 增加腦缺血風險.


Dexamethasone should be added to the treatment regimen of patients with concurrent HAPE and HACE at the doses described earlier for patients with HACE. Some patients with HAPE may have neurologic dysfunction caused by hypoxic encephalopathy rather than caused by HACE, but making the distinction between hypoxic encephalopathy and HACE in the field can be difficult. Therefore, dexamethasone should be added to the treatment regimen for patients with HAPE with neurologic dysfunction that does not resolve rapidly with administration of supplemental oxygen and improvement in oxygen saturation. If supplemental oxygen is not available, dexamethasone should be started in addition to the medications for HAPE in patients with altered mental status and/or suspected concurrent HACE. Nifedipine or other pulmonary vasodilators may be used in patients with concurrent HAPE and HACE, with care to avoid lowering mean arterial pressure, as this may decrease cerebral perfusion pressure and thus increase the risk for cerebral ischemia.

野外與登山醫學---38 Acute altitude illness WMS 2019 update HAPE TREATMENT SUGGESTED APPROACH 38

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2019 Update

中文翻譯目錄

統一名詞翻譯
AMS 急性高山病
HACE 高海拔腦水腫
HAPE 高海拔肺水腫
acute altitude illness 急性高海拔疾病

高海拔肺水腫治療建議
SUGGESTED APPROACH TO HAPE TREATMENT

開始治療之前, 要考慮其他在高海拔會造成呼吸症狀的情況, 例如 氣喘, 氣管痙孿, 痰卡住, 肺炎, 氣胸, 肺栓塞, 感冒, 心肌梗塞.
Before initiating treatment, 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, or myocardial infarction.

如果懷疑罹患 HAPE. 若有氧氣應開始給氧治療, 並降低海拔高度, 若無法立即下降高度 或 需要延緩下降, 應考慮持續給氧, 或使用加壓艙, 若患者能接受氧氣治療, 且在醫療環境受到適當的監視, 例如加護病房或急診室, 可以不用下降至低海拔, 在相同的海拔使用氧氣治療.
If HAPE is suspected or diagnosed, oxygen should be started if available, and descent to lower elevation should be initiated. If descent is infeasible or delayed, supplemental oxygen should be continued or the individual should be placed in a portable hyperbaric chamber. Patients who have access to supplemental oxygen and can be adequately monitored in a medical setting (eg, urgent care clinic or emergency department) may not need to descend to lower elevation and can be treated with oxygen alone at the current elevation.

如果給氧或使用持續性陽壓呼吸器之後, 氧氣飽和度沒有改善. 或氧氣飽和度改善(>90%)但仍病況惡化, 或經過適當處置之後, 病況沒有改善, 應立即下降.
Descent should be initiated, however, if oxygenation fails to improve with supplemental oxygen and/or CPAP, if the patient’s condition deteriorates despite achieving an oxygen saturation >90%, or if the patient fails to show signs of improvement with appropriate interventions for HAPE.


In more remote settings, early descent should be considered. Addition of nifedipine may not yield additional benefit in well-monitored settings.93,96 In the field setting, where resources are limited, nifedipine can be used as an adjunct to descent, supplemental oxygen, or portable hyperbaric therapy. It should only be used as primary therapy if none of these other measures is available. A phosphodiesterase inhibitor may be used if nifedipine is not available, but concurrent use of multiple pulmonary vasodilators is not recommended. In the hospital setting, CPAP can be considered as an adjunct to supplemental oxygen and nifedipine can be added if the patient fails to respond to oxygen therapy alone. There is no established role for beta-agonists, diuretics, acetazolamide, or dexamethasone in the treatment of HAPE, although, as noted below, dexamethasone should be considered when concern is raised for concurrent HACE. Selected patients (able to achieve an oxygen saturation >90%, with adequate support from family or friends, with adequate housing or lodging arrangements) may be discharged from direct medical care if they can continue using supplemental oxygen rather than being admitted to a healthcare facility. Individuals treated in this manner should be admitted to the hospital if they develop worsening symptoms and/or oxygen saturation while on supplemental oxygen. Descent to lower elevation should be pursued if oxygenation or other aspects of their condition worsen despite appropriate interventions for HAPE, as this suggests they may have alternative pathology that requires further evaluation and management. Individuals who develop HAPE may consider further ascent to higher altitude or reascent only when symptoms of HAPE have completely resolved and they maintain stable oxygenation at rest and with mild exercise while off supplemental oxygen and/or vasodilator therapy. Consideration may be given to using nifedipine or another pulmonary vasodilator upon resuming ascent

野外與登山醫學~~---36--WMS 2019 update HAPE TREATMENT Diuretics/Acetazolamide 36

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2019 Update
統一名詞翻譯
AMS 急性高山病
HACE 高海拔腦水腫
HAPE 高海拔肺水腫
acute altitude illness 急性高海拔疾病

Diuretics
Although their use is documented in older reports,100 diuretics have no role in HAPE treatment, particularly because many patients with HAPE have intravascular volume depletion. Recommendation. Diuretics should not be used for treatment of HAPE. Recommendation Grade: 1C.

Acetazolamide
Although clinical reports document use of acetazolamide for treatment of HAPE,97,98 there are no systematic studies examining its role in HAPE treatment. The diuretic effect might provoke hypotension in the intravascularly depleted patient, and the added stimulus to ventilation might worsen dyspnea. Recommendation. Acetazolamide should not be used for treatment of HAPE. Recommendation Grade: 1C

野外與登山醫學---37-WMS 2019 update HAPE TREATMENT Dexamethasone 37

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2019 Update
統一名詞翻譯
AMS 急性高山病
HACE 高海拔腦水腫
HAPE 高海拔肺水腫
acute altitude illness 急性高海拔疾病

過去的研究發現地塞米松(下面直接稱類固醇)可能有預防 HAPE的效果. 且會影響低血氧環境的最大運動耐力. 肺部發炎, 離子運輸功能. 有人猜測類固醇或許能用於治療 HAPE. 但目前尚無研究證實. 因此並未將類固醇放入HAPE治療選項. 

Dexamethasone地塞米松
Considering its potential role in HAPE prevention noted earlier and studies demonstrating effects on maximum exercise capacity,101 pulmonary inflammation, and ion transporter function in hypoxia,102 dexamethasone may have a role in HAPE treatment. Although reports document clinical use in this regard,98 no study has established whether it is effective for this purpose. Recommendation. Because of insufficient evidence, no recommendation can be made regarding dexamethasone for HAPE treatment.