短期进入高原从事高强度工作所致高原反应是值得探讨的问题,查阅文献,探讨其病因及发病机理、临床表现,总结国内外在诊断、预防及治疗方面的经验,探索一套可行、有效的预防及治疗措施,具有重要的临床意义。
Objective To compare the effects of oxygen therapy and local pressurization in alleviating plateau hypoxia at high altitude. Methods Forty-five healthy male soldiers were investigated at an altitude of 3992 meters. The subjects were randomly divided into three groups, ie. an oxygen inhalation group, a single-soldier oxygen increasing respirator ( SOIR) group and a BiPAP group. The oxygen inhalation group was treated with oxygen inhalation via nasal catheter at 2 L/ min. SOIR was used to assist breath in the SOIR group. The BiPAP group were treated with bi-level positive airway pressure ventilation, with IPAP of 10 cm H2O and EPAP of 4 cmH2 O. PaO2, PaCO2, SpO2 and heart rate were measured before and 30 minutes after the treatment. Results There were continuous increase of PaO2 from ( 53. 30 ±4. 88) mm Hg to( 58. 58 ±5. 05) mm Hg and ( 54. 43 ±3. 01) mm Hg to ( 91. 36 ±10. 99) mm Hg after BiPAP ventilation and oxygen inhalation, respectively ( both P lt; 0. 01) . However, the PaO2 of the SOIR group was decreased from( 56. 00 ±5. 75) mm Hg to ( 50. 82 ±5. 40) mm Hg( P lt; 0. 05 ) . In the other hand, the PaCO2 was increased from ( 30. 41 ±1. 51) mmHg to ( 32. 56 ±2. 98) mm Hg in the oxygen inhalation group ( P lt; 0. 05) , declined from( 28. 74 ±2. 91) mm Hg to ( 25. 82 ±4. 35) mm Hg in the BiPAP group( P lt;0. 05) ,and didn’t change significantly from( 28. 65 ±2. 78) mm Hg to ( 29. 75 ±3. 89) mmHg in the SOIR group ( P gt;0. 05) . Conclusions Both BiPAP ventilation and oxygen inhalation can alleviate plateau hypoxia by improving PaO2 at 3992 meter altitude while SOIR has no significant effect.
Objective To assess the acute high altitude sickness (AHAS) and its risk factors among public health emergency responders, so as to provide scientific proof for guaranteeing the safety and health of emergency rescue workers. Methods?The self-administered questionnaire aim at learning AHAS occurrence and its risk factors were distributed to 67 members from 4 teams at different altitudes selected among 35 rescue teams. The AHAS could be diagnosed by a total score of more than or equal to 5 within 3 days since arrival, as in the following detail: 1-3 score could be assigned in accordance with the following symptoms in degrees of the mild, moderate or severe, respectively: headache, nausea or vomiting, lassitude, dizziness and blurred vision, and sleep disorder; and 1 score could be assigned for each of the following symptoms: palpitation, shortness of breath, nosebleed, chest distress, diarrhea, constipation, cyanochroia of the lips, numbness in hands and feet, and dry cough. Results?A total of 54 among 67 (81%) responders completed the questionnaire, among whom 93% were males and the median age was 36 with the scope from 24 to 55, and 63% (34 respondents) developed AHAS. The univariate analysis showed that the altitude of the responders’ original residence (10 score for “lt;100 m” vs. 5.2 score for “gt;1 000 m”, P=0.005), experiences in high altitude areas (10 score for “having not” vs. 6.4 score for “having”, P=0.039), length of stay in an area over 2 000 m altitude before arrival (9.4 score for “≥3 days” vs. 5.7 score for “≤1 day”, P=0.011), luggage weight (9.8 score for “≥25 kg” vs. 5.5 score for “lt;25 kg”, P=0.002) were correlated with AHAS severity. The multivariate linear regression indicated that the lower altitude of the responders’ original residence and the short stay in an area over 2000m altitude before arrival were the factors influencing the severity of AHAS. The linear regression formulation was Y= 2.89 - 0.187 × the altitude of the responders’ original residence (pre 100m) + 2.43 × the length of stay in an area over 2000m altitude before arriving at Yushu (day). Conclusions?The past experiences and the pre-arrival preparation are critical factors of AHAS. Measures should be taken to protect the safety and health of responders dispatched to high altitude areas.
ObjectiveTo discuss the treatment and nursing care for Daocheng tourists with acute altitude sickness, and analyze its related factors. MethodsFrom April to September 2012, 236 Daocheng tourists with acute altitude sickness were given drugs in time, and underwent oxygen inspiration. On the basis of observing the disease, nurses also provided care and health education to the patients. ResultsBy guiding patients' psychology, diet, oxygen uptake, medication and health related education, we cured 234 patients, and the rest 2 with high altitude cerebral edema were cured after being transferred to low-lying areas. ConclusionTourists from low-lying areas are vulnerable to altitude sickness when touring high lands. Preventive medicine before entering highland areas, more rest and less exercise are important factors to prevent the occurrence of altitude sickness. Health education from nursing care providers can effectively guarantee the safety of tourists entering plateau.
In 2019, the American Wilderness Medical Society updated and released a new version of the practice guidelines based on the practice guidelines for the prevention and treatment of acute altitude illness first published in 2010 and updated in 2014. This article interprets the guidelines, focusing on effective measures to prevent and treat different forms of acute altitude illness, as well as suggestions for specific methods to manage the disease, with a view to providing help for clinicians in better practice.
Objective To investigate the psychological stress level and its influence factors of the motor transport soldiers in Military Station C at high altitude, and provide the data basis for the proper stress management. Methods A cluster random sampling was performed on the motor transport soldiers in Military Station C. And SCL-90 were adopted to measure the psychological stress level of the motor transport soldiers while the self-made basic information questionnaire was conducted to collect the information of demographic characteristic, length of military service, driving years. Then the effect of basic information on the psychological stress level was analyzed. Results 1 692 soldiers in Military Station C were enrolled in this survey. The scores of somatization, depression, psychosis and the total score of the SCL-90 of these soldiers were higher than the norm (allP values<0.001). The scores of interpersonal relationship, depression, terror and stubborn of the only child were higher than those of non-only-child (P=0.034,P=0.039,P=0.025,P=0.002). The scores of interpersonal relationship and anxiety were positively correlated with their education levels (P=0.008,P=0.026). The compulsory servicemen had higher scores of anxiety, terror and psychosis (P<0.001,P=0.026,P=0.001) but lower scores of somatization (P<0.001) compared with the sergeants. Those who suffered from neck discomfort had higher somatization scores (P<0.001). Conclusion Some factors involved in psychological stress level of the motor transport soldiers in Military Station C are higher than the norm, suggesting that more attention should be paid to their psychological states by the army administrators and the health management department, especially the only child, new recruits, junior soldiers and those who suffers from somatization discomfort.
Objective To investigate the safety of thoracic surgery for high-altitude patients in local medical center. MethodsWe retrospectively collected 258 high-altitude patients who received thoracic surgery in West China Hospital, Sichuan University (plain medical center, 54 patients) and People's Hospital of Ganzi Tibetan Autonomous Prefecture (high-altitude medical center, 204 patients) from January 2013 to July 2019. There were 175 males and 83 females with an average age of 43.0±16.8 years. Perioperative indicators, postoperative complications and related risk factors of patients were analyzed. ResultsThe rate of minimally invasive surgery in the high-altitude medical center was statistically lower than that in the plain medical center (11.8% vs. 55.6%, P<0.001). The surgical proportions of tuberculous empyema (41.2% vs. 1.9%, P<0.001) and pulmonary hydatid (15.2% vs. 0.0%, P=0.002) in the high-altitude medical center were statistically higher than those in the plain medical center. There was no statistical difference in perioperative mortality (0.5% vs. 1.9%, P=0.379) or complication rate within 30 days after operation (7.4% vs. 11.1%, P=0.402) between the high-altitude center and the plain medical center. Univariate and multivariate analyses showed that body mass index≥25 kg/m2 (OR=8.647, P<0.001) and esophageal rupture/perforation were independent risk factors for the occurrence of postoperative complications (OR=15.720, P<0.001). ConclusionThoracic surgery in the high-altitude medical center is safe and feasible.