Krabbe C, Hammerer M, Kritzinger K
Abteilung für Innere Medizin, Krankenhauses Mittersill.
Dtsch Med Wochenschr. 1999 Jun 11;124(23):721-6. doi: 10.1055/s-2007-1024403.
A 51-year-old man without significant previous illness presented with treatment-resistant arterial hypertension, dyspnoea, increased fatigue and headaches. Except for a florid face and fine tremor the physical examination was unremarkable.
The chest x-ray showed pulmonary congestion. Blood gas analysis indicated respiratory alkalosis and hypoxaemia (pO2 65.2 mm Hg, pCO2 33.9 mm Hg, pH 7.46) and polycythaemia (haemoglobin 18.1 g/dl, haematocrit 53.5%). There was no evidence of an underlying cardiopulmonary disease. Sleep apnoea screening with an 8-channel recorder was compatible with the central sleep apnoea syndrome (apnoea/hypopnoea index 38/h).
In the absence of neurological findings and an underlying medical condition the patient was again questioned. This revealed that in the previous 3 months he had been living and working as a waiter at a height of 3029 m above sea-level, without prior acclimatization. The symptoms and abnormal findings cleared up after a 6-week stay at 800 m.
At a time when people often quickly move between different altitudes, high-altitude sickness should be included in the differential diagnosis of respiratory failure and the central sleep apnoea syndrome.
一名51岁男性，既往无重大疾病史，出现难治性动脉高血压、呼吸困难、疲劳加重及头痛症状。除面色潮红和细微震颤外，体格检查无异常。
胸部X光显示肺充血。血气分析提示呼吸性碱中毒和低氧血症（动脉血氧分压65.2 mmHg，动脉血二氧化碳分压33.9 mmHg，pH值7.46）及红细胞增多症（血红蛋白18.1 g/dl，血细胞比容53.5%）。未发现潜在心肺疾病证据。使用8通道记录仪进行睡眠呼吸暂停筛查，结果符合中枢性睡眠呼吸暂停综合征（呼吸暂停/低通气指数38次/小时）。
在未发现神经系统体征及潜在内科疾病的情况下，再次询问患者。结果发现，在过去3个月里，他一直在海拔3029米处担任服务员，此前未进行过高原适应。在海拔800米处停留6周后，症状及异常检查结果消失。
在人们经常快速在不同海拔间移动的时代，高原病应纳入呼吸衰竭及中枢性睡眠呼吸暂停综合征的鉴别诊断中。
