Institute of Occupational & Social Medicine, RWTH Aachen Technical University, 52074 Aachen, Germany.
Department of Operative Dentistry, Periodontology & Preventive Dentistry, RWTH Aachen Technical University, 52074 Aachen, Germany.
Int J Environ Res Public Health. 2022 Oct 26;19(21):13887. doi: 10.3390/ijerph192113887.
At altitudes above 2500 m, the risk of developing high altitude pulmonary edema (HAPE) grows with the increases in pulmonary arterial pressure. HAPE is characterized by severe pulmonary hypertension, though the incidence and relevance of individual risk factors are not yet predictable. However, the systolic pulmonary pressure (SPAP) and peak in tricuspid regurgitation velocity (TVR) are crucial factors when diagnosing pulmonary hypertension by echocardiography.
The SPAP and TVR of 27 trekkers aged 20-65 years en route to the Solu Khumbu region of Nepal were assessed. Echocardiograph measurements were performed at Lukla (2860 m), Gorak Shep (5170 m), and the summit of Kala Patthar (5675 m). The altitude profile and the participants' characteristics were also compiled for correlation with the measured data.
The results showed a highly significant increase in SPAP and TVR after ascending Kala Patthar. The study revealed a lower increase of SPAP and TVR in the group of older participants, although the respective initial measurements at Gorak Shep were significantly higher for this group. A similar finding occurred in those using Diamox as prophylaxis. There was an inverse relationship between TVR and SPAP, the peripheral capillary oxygen saturation, and heart rate.
The echocardiograph results indicated that older people are an at-risk group for developing HAPE. A conservative interpretation of the basic tactical rules for altitudes should be followed for older trekkers or trekkers with known problems of altitude acclimatization ("slow acclimatizer") as SPAP elevates with age. The prophylactic use of Acetazolamide (Diamox) should be avoided where not necessary for acute medical reasons. Acetazolamide leads to an increase of SPAP, and this may potentially enhance the risk of developing HAPE. Arterial oxygen saturation measurements can provide an indicator for the self-assessment for the risk of developing HAPE and a rule of thumb for the altitude profile, but does not replace a HAPE diagnosis. Backpack weight, sex, workload (actual ascent speed), and pre-existing diseases were not statistically significant factors related to SPAP and TVR ( ≤ 0.05).
在海拔 2500 米以上的高度，肺动脉压升高会增加发生高原肺水肿（HAPE）的风险。HAPE 的特征是严重的肺动脉高压，尽管个体危险因素的发生率和相关性尚无法预测。然而，通过超声心动图诊断肺动脉高压时，收缩期肺动脉压（SPAP）和三尖瓣反流速度峰值（TVR）是至关重要的因素。
对 27 名年龄在 20-65 岁之间的徒步旅行者在前往尼泊尔索鲁昆布地区的途中的 SPAP 和 TVR 进行评估。在卢卡拉（2860 米）、戈拉克谢普（5170 米）和卡拉帕塔尔峰（5675 米）进行超声心动图测量。还编制了海拔剖面图和参与者特征，以与测量数据相关联。
结果显示，攀登卡拉帕塔尔峰后 SPAP 和 TVR 显著升高。研究表明，年龄较大的参与者 SPAP 和 TVR 的升高幅度较低，尽管该组在戈拉克谢普的初始测量值明显较高。使用 Diamox 作为预防措施的人也有类似的发现。TVR 与 SPAP、外周毛细血管血氧饱和度和心率呈负相关。
超声心动图结果表明，老年人是发生 HAPE 的高危人群。对于年龄较大的徒步旅行者或已知对高原适应有问题的徒步旅行者（“适应较慢者”），应遵循对高海拔基本战术规则的保守解释，因为 SPAP 会随年龄增长而升高。在没有急性医疗原因的情况下，应避免不必要地使用乙酰唑胺（Diamox）进行预防。乙酰唑胺会导致 SPAP 升高，这可能会增加发生 HAPE 的风险。动脉血氧饱和度测量值可以为评估发生 HAPE 的风险提供指标，并为海拔剖面提供经验法则，但不能替代 HAPE 诊断。背包重量、性别、工作量（实际上升速度）和既往疾病不是与 SPAP 和 TVR 相关的统计学显著因素（≤0.05）。
