Hultgren H N
Division of Cardiovascular Medicine, Stanford University School of Medicine, California 94305, USA.
Annu Rev Med. 1996;47:267-84. doi: 10.1146/annurev.med.47.1.267.
High-altitude pulmonary edema (HAPE) occurs in unacclimatized individuals who are rapidly exposed to altitudes in excess of 2450 m. It is commonly seen in climbers and skiers who ascend to high altitude without previous acclimatization. Initial symptoms of dyspnea, cough, weakness, and chest tightness appear, usually within 1-3 days after arrival. Common physical signs are tachypnea, tachycardia, rales, and cyanosis. Descent to a lower altitude, nifedipine, and oxygen administration result in rapid clinical improvement. Physiologic studies during the acute stage have revealed a normal pulmonary artery wedge pressure, marked elevation of pulmonary artery pressure, severe arterial unsaturation, and usually a low cardiac output. Pulmonary arteriolar (precapillary) resistance is elevated. A working hypothesis of the etiology of HAPE suggests that hypoxic pulmonary vasoconstriction is extensive but not uniform. The result is overperfusion of the remaining patent vessels with transmission of the high pulmonary artery pressure to capillaries. Dilatation of the capillaries and high flow results in capillary injury, with leakage of protein and red cells into the alveoli and airways. HAPE represents one of the few varieties of pulmonary edema where left ventricular filling pressure is normal.
高原肺水肿（HAPE）发生于未适应高原环境的个体，这些人迅速暴露于海拔超过2450米的高度。它常见于未经预先适应就登上高原的登山者和滑雪者。最初的症状如呼吸困难、咳嗽、乏力和胸闷通常在到达高原后1 - 3天内出现。常见的体征有呼吸急促、心动过速、啰音和发绀。下降到较低海拔、服用硝苯地平和吸氧可使临床症状迅速改善。急性期的生理学研究显示肺动脉楔压正常、肺动脉压显著升高、严重的动脉血氧不饱和，且通常心输出量较低。肺小动脉（毛细血管前）阻力升高。关于HAPE病因的一个可行假说是，缺氧性肺血管收缩广泛但不均匀。结果是剩余开放血管过度灌注，肺动脉高压传递至毛细血管。毛细血管扩张和高流量导致毛细血管损伤，蛋白质和红细胞漏入肺泡和气道。HAPE是少数几种左心室充盈压正常的肺水肿类型之一。
