高原旅行基本医疗建议。
Basic medical advice for travelers to high altitudes.
机构信息
Medizinische Universitätsklinik Heidelberg, Innere Medizin VII Sportmedizin.
出版信息
Dtsch Arztebl Int. 2011 Dec;108(49):839-47; quiz 848. doi: 10.3238/arztebl.2011.0839. Epub 2011 Dec 9.
BACKGROUND
High-altitude travel, for mountain climbing, trekking, or sightseeing, has become very popular. Therefore, the awareness of its dangers has increased, and many prospective travelers seek medical advice before setting forth on their trip.
METHODS
We selectively searched the literature for relevant original articles and reviews about acclimatization to high altitude and about high-altitude-related illnesses, including acute mountain sickness (AMS), high-altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE) (search in Medline for articles published from 1960-2010).
RESULTS
High-altitude-related illnesses are caused by hypoxia and the resulting hypoxemia in otherwise healthy persons who travel too high too fast, with too little time to become acclimatized. The individual susceptibility to high-altitude-related illness is a further risk factor that can only be recognized in persons who have traveled to high altitudes in the past. In an unselected group of mountain climbers, 50% had AMS at 4500 meters, while 0.5-1% had HACE and 6% had HAPE at the same altitude. Persons with preexisting illnesses, particularly of the heart and lungs, can develop symptoms of their underlying disease at high altitudes because of hypoxia. Thus, medical advice is based on an assessment of the risk of illness in relation to the intended altitude profile of the trip, in consideration of the prospective traveler's suitability for high altitudes (cardiopulmonary performance status, exercise capacity) and individual susceptibility to high-altitude-related illnesses, as judged from previous exposures. The symptoms and treatment of high-altitude-related illnesses should be thoroughly explained.
CONCLUSION
An understanding of the physiology of adaptation to high altitudes and of the pathophysiology and clinical manifestations of high-altitude-related illnesses provides a basis for the proper counseling of prospective travelers, through which life-threatening conditions can be prevented.
背景
高海拔旅行，无论是登山、徒步旅行还是观光，都变得非常流行。因此，人们对其危险的认识有所提高，许多潜在的旅行者在出发前会寻求医学建议。
方法
我们有选择地搜索了有关高原适应和与高原相关疾病的文献，包括急性高原病（AMS）、高原脑水肿（HACE）和高原肺水肿（HAPE）（从 1960 年至 2010 年在 Medline 上搜索发表的文章）。
结果
高原相关疾病是由健康人在海拔过高、过快、适应时间过短的情况下缺氧和由此导致的低血氧引起的。个体对高原相关疾病的易感性是进一步的风险因素，只有在过去曾前往高海拔地区的人才能识别。在一组未经选择的登山者中，50%的人在海拔 4500 米时出现 AMS，而 0.5-1%的人在同一海拔高度时出现 HACE，6%的人出现 HAPE。患有既往疾病的人，特别是心肺疾病，由于缺氧，可能会在高海拔地区出现其基础疾病的症状。因此，医疗建议是基于对疾病风险的评估，与旅行计划的预期海拔剖面相关，考虑到潜在旅行者是否适合高海拔（心肺功能状态、运动能力）和个体对高原相关疾病的易感性，从以前的暴露情况来判断。应彻底解释高原相关疾病的症状和治疗方法。
结论
对高原适应的生理学以及高原相关疾病的病理生理学和临床表现的理解为潜在旅行者提供了适当咨询的基础，可以预防危及生命的情况。
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