Leshem Eyal, Pandey Prativa, Shlim David R, Hiramatsu Kazuko, Sidi Yechezkel, Schwartz Eli
Center for Geographic Medicine, Sheba Medical Center, Tel Hashomer, Israel.
J Travel Med. 2008 Sep-Oct;15(5):315-22. doi: 10.1111/j.1708-8305.2008.00229.x.
Trekking in Nepal is a popular adventure travel activity involving more than 80,000 people of all ages annually. This study focuses on the demographic characteristics and clinical course of altitude illness patients evacuated to Kathmandu and estimates the rates of evacuation in different regions of Nepal.
During the years 1999 to 2006, all patients who presented with altitude illness to the CIWEC clinic in Kathmandu were evaluated and included in the study if the final diagnosis was compatible with high-altitude cerebral edema (HACE), high-altitude pulmonary edema (HAPE), or acute mountain sickness (AMS). Altitude illness-related deaths were reported according to death certificates issued by selected embassies in Kathmandu.
A total of 406 patients were evaluated, among them 327 retrospectively and 79 prospectively. HACE was diagnosed in 21%, HAPE in 34%, combined HAPE and HACE in 27%, and AMS in 18%. Mean patient age was older than trekker controls (44 +/- 13.5 vs 38.6 +/- 13.9 y, p < 0.0001). Everest region trekkers were more likely to be evacuated for altitude illness than trekkers in other regions. The estimated incidence of altitude illness-related death was 7.7/100,000 trekkers. Most altitude illness symptoms resolved completely within 2 days of evacuation.
Altitude illness that results in evacuation occurs more commonly among trekkers in the Everest region and among older trekkers. The outcome of all persons evacuated for altitude illness was uniformly good, and the rate of recovery was rapid. However, the incidence of altitude illness-related death continued to rise over past decade.
在尼泊尔徒步旅行是一项热门的冒险旅游活动，每年有超过8万名各年龄段的人参与。本研究聚焦于被疏散至加德满都的高原病患者的人口统计学特征和临床病程，并估算尼泊尔不同地区的疏散率。
在1999年至2006年期间，所有在加德满都的CIWEC诊所就诊的高原病患者均接受了评估，若最终诊断与高原脑水肿（HACE）、高原肺水肿（HAPE）或急性高山病（AMS）相符，则纳入研究。根据加德满都部分大使馆出具的死亡证明报告与高原病相关的死亡情况。
共评估了406例患者，其中327例为回顾性研究，79例为前瞻性研究。诊断为HACE的占21%，HAPE的占34%，HAPE和HACE合并的占27%，AMS的占18%。患者的平均年龄大于徒步旅行者对照组（44±13.5岁对38.6±13.9岁，p<0.0001）。与其他地区的徒步旅行者相比，珠穆朗玛峰地区的徒步旅行者因高原病被疏散的可能性更大。与高原病相关的死亡估计发生率为7.7/10万徒步旅行者。大多数高原病症状在疏散后2天内完全缓解。
导致被疏散的高原病在珠穆朗玛峰地区的徒步旅行者和年龄较大的徒步旅行者中更为常见。所有因高原病被疏散者的预后均良好，恢复速度很快。然而，在过去十年中，与高原病相关的死亡发生率持续上升。
