Luks Andrew M, Swenson Erik R
1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington , Seattle, Washington.
2 Division of Pulmonary and Critical Care Medicine. VA Puget Sound Health Care System , Seattle, Washington.
High Alt Med Biol. 2015 Jun;16(2):80-8. doi: 10.1089/ham.2014.1122. Epub 2015 Apr 6.
Luks, Andrew M., and Erik R. Swenson. Clinician's Corner: Evaluating the risks of high altitude travel in chronic liver disease patients. High Alt Med Biol 16:80-88, 2015.--With improvements in the quality of health care, people with chronic medical conditions are experiencing better quality of life and increasingly participating in a wider array of activities, including travel to high altitude. Whenever people with chronic diseases travel to this environment, it is important to consider whether the physiologic responses to hypobaric hypoxia will interact with the underlying medical condition such that the risk of acute altitude illness is increased or the medical condition itself may worsen. This review considers these questions as they pertain to patients with chronic liver disease. While the limited available evidence suggests there is no evidence of liver injury or dysfunction in normal individuals traveling as high as 5000 m, there is reason to suspect that two groups of cirrhosis patients are at increased risk for problems, hepatopulmonary syndrome patients, who are at risk for severe hypoxemia following ascent, and portopulmonary hypertension patients who may be at risk for high altitude pulmonary edema and acute right ventricular dysfunction. While liver transplant patients may tolerate high altitude exposure without difficulty, no information is available regarding the risks of long-term residence at altitude with chronic liver disease. All travelers with cirrhosis require careful pre-travel evaluation to identify conditions that might predispose to problems at altitude and develop risk mitigation strategies for these issues. Patients also require detailed counseling about recognition, prevention, and treatment of acute altitude illness and may require different medication regimens to prevent or treat altitude illness than used in healthy individuals.
卢克斯，安德鲁·M.，以及埃里克·R.斯文森。临床医生视角：评估慢性肝病患者高原旅行的风险。《高海拔医学与生物学》16:80 - 88，2015年。——随着医疗保健质量的提高，患有慢性疾病的人们生活质量得到改善，并越来越多地参与到更广泛的活动中，包括前往高海拔地区旅行。每当患有慢性疾病的人前往这种环境时，重要的是要考虑对低压缺氧的生理反应是否会与潜在的疾病相互作用，从而增加急性高原病的风险，或者疾病本身可能会恶化。本综述探讨了这些与慢性肝病患者相关的问题。虽然有限的现有证据表明，前往高达5000米的正常个体没有肝损伤或功能障碍的证据，但有理由怀疑两组肝硬化患者出现问题的风险增加，即肝肺综合征患者，他们在登高后有发生严重低氧血症的风险，以及门脉高压性肺动脉高压患者，他们可能有发生高原肺水肿和急性右心室功能障碍的风险。虽然肝移植患者可能能够轻松耐受高海拔暴露，但关于慢性肝病患者长期居住在高原的风险尚无信息。所有肝硬化患者在旅行前都需要仔细评估，以识别可能导致在高原出现问题的情况，并针对这些问题制定风险缓解策略。患者还需要接受关于急性高原病的识别、预防和治疗的详细咨询，并且可能需要与健康个体不同的药物治疗方案来预防或治疗高原病。
