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磺胺類藥物過敏 -> 避免使用 acetazolamide
HACE 治療主要是 Dexa ; Acetazolamide as an adjunct for acute management
體細胞缺氧時, 為了提供更多氧
供應的血管擴張與通透性增加, 造成局部水腫
開始通常是頭痛, 嚴重的腦水腫則會致命 (Cerebral vasodilation)
肺泡細胞則相反, 缺氧的肺泡失去氧氣交換的意義, 因此血管反而收縮
以提升含氧較高的肺泡血流, 造成肺高壓與肺水腫
高海拔症候群 High-altitude syndromes :
Acute hypoxia, AMS, HAPE, high-altitude cerebral edema (HACE),
retinopathy, peripheral edema, sleeping problems, and groups of neurologic syndromes.
以上核心原因都是 Hypoxia, 最重點治療都是 Descent and Oxygen
AMS (Acute mountain sickness)
最核心的症狀就是 頭痛
急性高山病像 宿醉
頭痛, 昏昏沉沉, 全身倦怠無力,
沒有胃口, 甚至會噁心嘔吐
Age has little influence on incidence, with children being as susceptible as adults,
although those > 50 years of age tend to have less AMS.
Obesity appears to increase the risk of AMS
SaO2 can be normal or slightly low for a given altitude.
The percent SaO2 correlates poorly with the diagnosis of AMS.
The onset of ataxia or altered level of consciousness heralds progression to HACE.
Coma may ensue within 12 hours if treatment is delayed.
Mild AMS : drop in altitude of only 300 -1000 m is usually effective to improve symptoms
Acetazolamide reduces renal reabsorption of bicarbonate,
causing a bicarbonate diuresis and metabolic acidosis that stimulates ventilation.
As a result, PaO2 rises and the deleterious effects of hypobaric hypoxia are reduced.
The drug also maintains cerebral blood flow despite greater hypocapnia.
Moderate to severe AMS : Dexamethasone
Dexamethasone is not useful for prophylaxis
高海拔腦水腫 HACE
症狀像酒精中毒
除了有 AMS 的症狀, 進一步還會嗜睡, 意識不清, 走路不穩
Altered mental status, ataxia, stupor, progression to coma if untreated.
can lead to focal neurologic signs such as 3rd or 6th cranial nerve palsies
MRI : increased T2 signaling in the splenium of the corpus callosum indicating edema
高海拔肺水腫 HAPE
症狀是喘
Noncardiogenic, hydrostatic edema
即使在輕微活動或者是休息時, 喘依然沒有改善, 並伴隨虛弱無力和咳嗽
Occurs more frequently then HACE
The condition in its early stage is easily reversible with descent and oxygen administration.
Left ventricular end-diastolic pressure, pulmonary artery wedge pressures, and left atrial pressures are low to normal,
cardiac output is low, and pulmonary vascular resistance and pulmonary artery pressure are markedly elevated
The culprit 核心 in HAPE is high microvascular pressure.
肺動脈, 肺微血管都是高壓
wedge pressures, 左心壓力都相對正常或低
Localized rales, usually in the right mid-lung field, are common
早期診斷很重要, 乾咳和運動狀況變差就要懷疑
越來越喘, 休息也喘是 HAPE 的重要症狀
Low-grade fever is common
Oxygen immediately lowers pulmonary artery pressure and improves arterial oxygenation.
The phosphodiesterase-5 inhibitors sildenafil and tadalafil blunt hypoxic pulmonary vasoconstriction
through generation of nitric oxide.
Inhaled salmeterol BID reduces the incidence of HAPE by 50%
高山症通常發生在海拔超過2800公尺以上的高山
因為是海拔高度變化太快引起的問題
預防高山症最好的方法就是給身體適應海拔變化的時間
一天上升的高度儘量不要超過500公尺, 最好要有足夠的身體適應期
預防高山症, 要準備兩類藥物 :
預防腦水腫的藥物首選 Acetazolamide ( Diamox 丹木斯 )
對磺胺類過敏或蠶豆症患者禁用, 可改用類固醇 Dexamethasone
預防肺高壓則使用降血壓藥 Nifedipine
若擔心血壓降太低可改用 Sildenafil ( Viagra 威而剛 )
但需避免和硝化甘油併用
登山前一天開始, 持續吃到攻頂後兩天為止
上山當天開始吃, 直到攻頂後二至三天為止
血壓原本就不高的人用了可能會讓血壓降得太低
這些藥品使用在預防或治療高山症或HAPE都是 off-labeled use
http://vaccine-bc-huang.blogspot.tw/2017/09/AMS-HACE-HAPE-Acetazolamide-Dexamethasone-Nifedipine-Sildenafil.html
http://jerryljw.blogspot.com/2017/04/prevention-and-management-of-acute.html
https://meddataspeaks.wordpress.com/2013/09/18/%E9%AB%98%E5%B1%B1%E7%97%87%E9%A0%90%E9%98%B2%E7%94%A8%E8%97%A5%E5%9F%BA%E6%9C%AC%E7%9F%A5%E8%AD%98/
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